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1.
BMC Gastroenterol ; 21(1): 95, 2021 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-33653284

RESUMEN

BACKGROUND: This randomized, open-label trial aimed to compare the efficacy of 10-day bismuth-containing quadruple therapy (BQT) with 7-day proton-pump inhibitor-clarithromycin containing standard triple therapy (STT) as an empirical first-line Helicobacter pylori therapy. METHODS: Participants with H. pylori infection were randomly assigned to either 10-day BQT (daily doses of bismuth 300 mg, four times; lansoprazole 30 mg, twice; metronidazole 500 mg, three times; and tetracycline 500 mg, four times) or 7-day STT (lansoprazole 30 mg; amoxicillin 1,000 mg; and clarithromycin 500 mg; each given twice daily). Participants who failed initial therapy were crossed over to the alternative treatment regimen. Primary outcome was the eradication rates of first-line treatment by intention-to-treat analysis. RESULTS: Study participants (n = 352) were randomized to receive either 10-day BQT (n = 175) or 7-day STT (n = 177). The BQT-group achieved a significantly higher eradication rate than the STT-group in the intention-to-treat analysis (74.3% vs 57.1%, respectively; P = 0.001), modified intention-to-analysis (87.2% [130/149] vs 68.7% [101/147], respectively; P < 0.001) and per-protocol analysis (92.9% [105/113] vs 70.1% [94/134], respectively; P < 0.001). Although there was no serious adverse event, the compliance was lower with BQT than STT as a higher proportion of participants in the BQT-group discontinued therapy because of adverse events than those in the STT-group (23.1% vs 9.1%, respectively; P = 0.001) CONCLUSIONS: Ten-day BQT had higher eradication rates compared to that of the 7-day STT as an empirical first-line treatment for H. pylori eradication in Korea. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02557932. Registered 23 September 2015, https://clinicaltrials.gov/ct2/show/NCT02557932?term=NCT02557932&draw=2&rank=1 .


Asunto(s)
Infecciones por Helicobacter , Helicobacter pylori , Amoxicilina/uso terapéutico , Antibacterianos/efectos adversos , Bismuto/uso terapéutico , Claritromicina/uso terapéutico , Quimioterapia Combinada , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Metronidazol/uso terapéutico , Inhibidores de la Bomba de Protones/uso terapéutico , República de Corea
2.
Exp Parasitol ; 224: 108103, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33771537

RESUMEN

In this work the effect of (-)-epicatechin on the development of amebic liver abscess in hamsters was evaluated. (-)-epicatechin is a flavonoid present in plants that possesses various biological properties, including its activity against some protozoal parasites; however its antiamebic activity in a living model had not been evaluated. Syrian golden hamsters were intrahepatically inoculated with 1x106E. histolytica trophozoites, three days after inoculation they received nine intraperitoneal doses of (-)-epicatechin (10 mg/100 g) every 48 h. Animals without treatments and treated with metronidazole were included as controls. Macroscopic characteristics of the hepatic abscess, histopathological analysis of the tissue and the levels of inflammatory cytokines were determined. (-)-epicatechin produced a decrease in liver abscess progression being observed only 9.49% of damage compared to 84% shown by untreated animals. During treatment with (-)-epicatechin hepatic tissue showed signs of liver repair and absence of amoebae. Additionally, (-)-epicatechin produced a modulating effect on inflammatory cytokines TNF-α, IL-1ß and IL-10. All these events observed in animals treated with (-)-epicatechin could contribute to the elimination of trophozoites and liver healing.


Asunto(s)
Catequina/uso terapéutico , Absceso Hepático Amebiano/prevención & control , Análisis de Varianza , Animales , Antiprotozoarios/uso terapéutico , Antiprotozoarios/toxicidad , Catequina/toxicidad , Cricetinae , Citocinas/análisis , Citocinas/metabolismo , Dimetilsulfóxido/toxicidad , Modelos Animales de Enfermedad , Hígado/inmunología , Absceso Hepático Amebiano/tratamiento farmacológico , Masculino , Mesocricetus , Metronidazol/uso terapéutico , Metronidazol/toxicidad , Reacción en Cadena en Tiempo Real de la Polimerasa
3.
J Med Microbiol ; 70(3)2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33625354

RESUMEN

Introduction. Cryptosporidium parvum causes intestinal parasitic infections affecting both immunosuppressed and immunocompetent individuals.Gap statement. Given the absence of effective treatments for cryptosporidiosis, especially in immunodeficient patients, the present study was designed to assess the therapeutic efficacy of secnidazole (SEC) and its combination with nitazoxanide (NTZ) in comparison to single NTZ treatment in relation to the immune status of a murine model of C. parvum infection.Methodology. The infected groups were administered NTZ, SEC or NTZ-SEC for three or five successive doses. At days 10 and 12 post-infection (p.i.), the mice were sacrificed, and the efficacy of the applied drugs was evaluated by comparing the histopathological alterations in ileum and measuring the T helper Th1 (interferon gamma; IFN-γ), Th2 [interleukin (IL)-4 and IL-10] and Th17 (IL-17) cytokine profiles in serum.Results. The NTZ-SEC combination recorded the maximal reduction of C. parvum oocyst shedding, endogenous stages count and intestinal histopathology, regardless of the immune status of the infected mice. The efficacy of NTZ-SEC was dependent on the period of administration, as the 5 day-based treatment protocol was also more effective than the 3 day-based one in terms of immunocompetence and immunosuppression. The present treatment schedule induced an immunomodulatory effect from SEC that developed a protective immune response against C. parvum infection with reduced production of serum IL-17, IFN-γ, IL-4 and IL-10.Conclusions. Application of NTZ-SEC combined therapy may be useful in treatment of C. parvum, especially in cases involving immunosuppression.


Asunto(s)
Antiprotozoarios/uso terapéutico , Criptosporidiosis/tratamiento farmacológico , Inmunomodulación/efectos de los fármacos , Metronidazol/análogos & derivados , Nitrocompuestos/uso terapéutico , Tiazoles/uso terapéutico , Animales , Criptosporidiosis/inmunología , Criptosporidiosis/parasitología , Criptosporidiosis/patología , Cryptosporidium parvum/efectos de los fármacos , Citocinas/sangre , Modelos Animales de Enfermedad , Esquema de Medicación , Quimioterapia Combinada , Íleon/efectos de los fármacos , Íleon/parasitología , Íleon/patología , Huésped Inmunocomprometido , Masculino , Metronidazol/uso terapéutico , Ratones , Carga de Parásitos
4.
Complement Ther Clin Pract ; 43: 101323, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33618288

RESUMEN

Pressure injury (PI) is a worldwide health problem that has attracted widespread attention from scientific and clinical research communities. PI incidence correlates with the increase of the aging population. In this situation, it is crucial to select effective and affordable drugs for patients and healthcare systems. Herein, we report a case of a 94-year-old female with a stage 2 PI wound, which was treated topically using a novel combination of mixed powders: metronidazole and nano pearl powders. Metronidazole is the preferred option to treat infected wounds due to its excellent antibacterial ability. However, some drawbacks have limited the use of metronidazole in PI wound management, such as its poor capacity to accelerate wound closure. Pearl powder has a strong capacity to promote wound healing and closure but has not been effective at resisting wound infection. To take advantage of powdered drugs' wound treatment properties and accelerate PI wound healing, we prepared powdered mixtures for wound application. Both drugs are cost-effective and were beneficial to wound healing. Therefore, the combination of metronidazole and pearl powders offer a promising choice to patients with PI wounds.


Asunto(s)
Metronidazol , Infección de Heridas , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Femenino , Humanos , Metronidazol/uso terapéutico , Polvos , Cicatrización de Heridas , Infección de Heridas/tratamiento farmacológico
5.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33541980

RESUMEN

Eosinophilic gastroenteritis is a rare inflammatory disorder of the gastrointestinal tract. Although commonly associated with allergic diseases, it is also rarely associated with autoimmune disorders. This case report describes a 17-year-old Filipino male with eosinophilic gastroenteritis, manifesting as abdominal pain, vomiting and diarrhoea. He had no allergic diseases, but he was previously diagnosed with chronic bullous disease. His symptoms improved with the initiation of corticosteroids. To date, this is the first case report of a patient with eosinophilic gastroenteritis and chronic bullous disease.


Asunto(s)
Enteritis/diagnóstico , Eosinofilia/diagnóstico , Gastritis/diagnóstico , Gastroenteritis/diagnóstico , Dolor Abdominal/etiología , Adolescente , Antiinfecciosos/uso terapéutico , Apendicitis/diagnóstico , Apendicitis/tratamiento farmacológico , Apendicitis/cirugía , Diarrea/etiología , Enteritis/tratamiento farmacológico , Enteritis/patología , Eosinofilia/tratamiento farmacológico , Eosinofilia/patología , Gastritis/tratamiento farmacológico , Gastritis/patología , Gastroenteritis/tratamiento farmacológico , Humanos , Masculino , Metronidazol/uso terapéutico , Epiplón/patología , Filipinas , Prednisona/uso terapéutico , Vómitos/etiología
7.
JAMA ; 325(4): 353-362, 2021 01 26.
Artículo en Inglés | MEDLINE | ID: mdl-33427870

RESUMEN

Importance: Antibiotics are an effective and safe alternative to appendectomy for managing uncomplicated acute appendicitis, but the optimal antibiotic regimen is not known. Objective: To compare oral antibiotics with combined intravenous followed by oral antibiotics in the management of computed tomography-confirmed uncomplicated acute appendicitis. Design, Setting, and Participants: The Appendicitis Acuta (APPAC) II multicenter, open-label, noninferiority randomized clinical trial was conducted from April 2017 until November 2018 in 9 Finnish hospitals. A total of 599 patients aged 18 to 60 years with computed tomography-confirmed uncomplicated acute appendicitis were enrolled in the trial. The last date of follow-up was November 29, 2019. Interventions: Patients randomized to receive oral monotherapy (n = 295) received oral moxifloxacin (400 mg/d) for 7 days. Patients randomized to receive intravenous antibiotics followed by oral antibiotics (n = 288) received intravenous ertapenem (1 g/d) for 2 days followed by oral levofloxacin (500 mg/d) and metronidazole (500 mg 3 times/d) for 5 days. Main Outcomes and Measures: The primary end point was treatment success (≥65%) for both groups, defined as discharge from hospital without surgery and no recurrent appendicitis during 1-year follow-up, and to determine whether oral antibiotics alone were noninferior to intravenous and oral antibiotics, with a margin of 6% for difference. Results: Among 599 patients who were randomized (mean [SD] age, 36 [12] years; 263 [44%] women), 581 (99.7%) were available for the 1-year follow-up. The treatment success rate at 1 year was 70.2% (1-sided 95% CI, 65.8% to ∞) for patients treated with oral antibiotics and 73.8% (1-sided 95% CI, 69.5% to ∞) for patients treated with intravenous followed by oral antibiotics. The difference was -3.6% ([1-sided 95% CI, -9.7% to ∞]; P = .26 for noninferiority), with the confidence limit exceeding the noninferiority margin. Conclusion and Relevance: Among adults with uncomplicated acute appendicitis, treatment with 7 days of oral moxifloxacin compared with 2 days of intravenous ertapenem followed by 5 days of levofloxacin and metronidazole resulted in treatment success rates greater than 65% in both groups, but failed to demonstrate noninferiority for treatment success of oral antibiotics compared with intravenous followed by oral antibiotics. Trial Registration: ClinicalTrials.gov Identifier: NCT03236961; EudraCT Identifier: 2015-003633-10.


Asunto(s)
Antibacterianos/uso terapéutico , Apendicitis/tratamiento farmacológico , Enfermedad Aguda , Administración Intravenosa , Administración Oral , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Apendicectomía , Apendicitis/diagnóstico por imagen , Apendicitis/cirugía , Quimioterapia Combinada , Ertapenem/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Levofloxacino/uso terapéutico , Masculino , Metronidazol/uso terapéutico , Persona de Mediana Edad , Moxifloxacino/uso terapéutico , Tomografía Computarizada por Rayos X , Adulto Joven
10.
BMC Gastroenterol ; 20(1): 424, 2020 Dec 14.
Artículo en Inglés | MEDLINE | ID: mdl-33317457

RESUMEN

BACKGROUND: Infection with Entamoeba histolytica and associated complications are relatively rare in developed countries. The overall low prevalence in the Western world as well as the possibly prolonged latency period between infection with the causing pathogen and onset of clinical symptoms may delay diagnosis of and adequate treatment for amoebiasis. Amoebic liver abscess (ALA) is the most common extraintestinal manifestation of invasive amoebiasis. Pregnancy has been described as a risk factor for development of invasive amoebiasis and management of these patients is especially complex. CASE PRESENTATION: A 30-year-old Caucasian woman in early pregnancy presented to our emergency department with abdominal pain alongside elevated inflammatory markers and liver function tests. Travel history revealed multiple journeys to tropic and subtropic regions during the past decade and a prolonged episode of intermittently bloody diarrhea during a five month stay in Indonesia seven years prior to admission. Sonographic and magnetic resonance imaging revealed a 5 × 4 cm hepatic abscess. After ultrasound-guided transcutaneous liver drainage, both abscess fluids and blood cultures showed neither bacterial growth nor microscopic signs of parasitic disease. Serological testing confirmed an infection with Entamoeba histolytica, which was treated with metronidazole, followed by eradication therapy with paromomycin. Subsequent clinical, laboratory and imaging follow-up exams showed regression of the ALA. In addition, the pregnancy completed without complications and a healthy baby boy was born 7 months after termination of treatment. CONCLUSIONS: This case of invasive amoebiasis in early pregnancy outside of endemic regions and several years after exposure demonstrates the importance of broad differential diagnostics in the context of liver abscesses. The complex interdisciplinary decisions regarding the choice of imaging techniques as well as interventional and antibiotic therapy in the context of pregnancy are discussed. Furthermore, we present possible explanations for pregnancy as a risk factor for an invasive course of amoebiasis.


Asunto(s)
Entamoeba histolytica , Entamebiasis , Absceso Hepático Amebiano , Adulto , Femenino , Humanos , Indonesia , Absceso Hepático Amebiano/diagnóstico , Absceso Hepático Amebiano/tratamiento farmacológico , Masculino , Metronidazol/uso terapéutico , Embarazo
12.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-33370946

RESUMEN

Acute gastroenteritis with persistent vomiting, high degree fever and blood streaking stools often suggests bacterial aetiology in children. Authors report a 13-year-old boy presenting with acute watery diarrhoea with persistent vomiting, fever of 103°F, abdominal cramps and blood streaking stools who failed to show any response to parenteral third-generation cephalosporin for 72 hours. The stool examination revealed numerous cystic and amoeboid forms of Blastocystis hominis Metronidazole was started and the boy promptly responded within 24 hours. There was no recurrence of symptoms then onwards. The case highlights the crucial stool examination in case of acute diarrhoeal disease for rare aetiology.


Asunto(s)
Antiprotozoarios/uso terapéutico , Infecciones por Blastocystis/diagnóstico , Blastocystis hominis/aislamiento & purificación , Gastroenteritis/diagnóstico , Enfermedad Aguda/terapia , Adolescente , Infecciones por Blastocystis/tratamiento farmacológico , Infecciones por Blastocystis/parasitología , Heces/parasitología , Gastroenteritis/tratamiento farmacológico , Gastroenteritis/parasitología , Humanos , Masculino , Metronidazol/uso terapéutico , Resultado del Tratamiento
13.
BMC Infect Dis ; 20(1): 834, 2020 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-33176727

RESUMEN

BACKGROUND: Bacterial vaginosis (BV) is estimated to affect 1 in 3 women globally and is associated with obstetric and gynaecological sequelae. Current recommended therapies have good short-term efficacy but 1 in 2 women experience BV recurrence within 6 months of treatment. Evidence of male carriage of BV-organisms suggests that male partners may be reinfecting women with BV-associated bacteria (henceforth referred to as BV-organisms) and impacting on the efficacy of treatment approaches solely directed to women. This trial aims to determine the effect of concurrent male partner treatment for preventing BV recurrence compared to current standard of care. METHODS: StepUp is an open-label, multicentre, parallel group randomised controlled trial for women diagnosed with BV and their male partner. Women with clinical-BV defined using current gold standard diagnosis methods (≥3 Amsel criteria and Nugent score (NS) = 4-10) and with a regular male partner will be assessed for eligibility, and couples will then be consented. All women will be prescribed oral metronidazole 400 mg twice daily (BID) for 7 days, or if contraindicated, a 7-day regimen of topical vaginal 2% clindamycin. Couples will be randomised 1:1 to either current standard of care (female treatment only), or female treatment and concurrent male partner treatment (7 days of combined antibiotics - oral metronidazole tablets 400 mg BID and 2% clindamycin cream applied topically to the glans penis and upper shaft [under the foreskin if uncircumcised] BID). Couples will be followed for up to 12 weeks to assess BV status in women, and assess the adherence, tolerability and acceptability of male partner treatment. The primary outcome is BV recurrence defined as ≥3 Amsel criteria and NS = 4-10 within 12 weeks of enrolment. The estimated sample size is 342 couples, to detect a 40% reduction in BV recurrence rates from 40% in the control group to 24% in the intervention group within 12 weeks. DISCUSSION: Current treatments directed solely to women result in unacceptably high rates of BV recurrence. If proven to be effective the findings from this trial will directly inform the development of new treatment strategies to impact on BV recurrence. TRIAL REGISTRATION: The trial was prospectively registered on 12 February 2019 on the Australian and New Zealand Clinical Trial Registry (ACTRN12619000196145, Universal Trial Number: U1111-1228-0106, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376883&isReview=true ).


Asunto(s)
Antibacterianos/uso terapéutico , Clindamicina/uso terapéutico , Metronidazol/uso terapéutico , Parejas Sexuales , Vaginosis Bacteriana/tratamiento farmacológico , Administración Intravaginal , Administración Oral , Antibacterianos/administración & dosificación , Australia , Clindamicina/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Metronidazol/administración & dosificación , Nueva Zelanda , Pene/microbiología , Estudios Prospectivos , Recurrencia , Resultado del Tratamiento , Vaginosis Bacteriana/microbiología
14.
Rev. patol. respir ; 23(3): 111-113, jul.-sept. 2020.
Artículo en Español | IBECS | ID: ibc-198474

RESUMEN

La amebiasis es una enfermedad infecciosa causada por el protozoo E. hystolitica con múltiples manifestaciones clínicas. La afectación torácica es la segunda localización extraintestinal más frecuente tras la hepática. Presentamos un caso de derrame pleural secundario a un absceso hepático amebiano y realizamos una revisión de esta entidad poco frecuente


Amebiasis is an infectious disease caused by the protozoan E. hystolitica with multiple clinical manifestations. Chest involvement is the second most frequent extraintestinal location after the liver. We present a case of pleural effusion secondary to an amebic liver abscess and we review this rare entity


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/etiología , Absceso Hepático Amebiano/complicaciones , Absceso Hepático Amebiano/diagnóstico por imagen , Radiografía Torácica , Tomografía Computarizada por Rayos X , Ultrasonografía , Derrame Pleural/tratamiento farmacológico , Absceso Hepático Amebiano/tratamiento farmacológico , Metronidazol/uso terapéutico , Antiprotozoarios/uso terapéutico
15.
Epidemiol Mikrobiol Imunol ; 69(2): 96-99, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32819109

RESUMEN

Neonatal pneumonia is mostly bacterial and other etiology is considered less frequently. We report a case of newborn whose neonatal pneumonia has not improved, despite the aggressive ventilation regime and empiric antibiotic therapy. A special sample from the respiratory tract was collected for PCR examination. The test confirmed the presence of Trichomonas vaginalis. Antibiotic therapy was extended to include metronidazole. Targeted antibiotic therapy, which lasted for 28 days, improved the condition and the patient was discharged in a stabilized condition to home care on the 44th day of life. We demonstrate the need to consider atypical pathogens in the case of infections that do not respond to conventional therapy. The multiplex real-time PCR technique was used to detect the DNA of the pathogen. Targeted antibiotic therapy is the result of pathogen identification.


Asunto(s)
Neumonía , Tricomoniasis , Trichomonas vaginalis , Humanos , Recién Nacido , Metronidazol/uso terapéutico , Reacción en Cadena de la Polimerasa Multiplex , Tricomoniasis/diagnóstico , Tricomoniasis/tratamiento farmacológico , Trichomonas vaginalis/genética
16.
Z Gastroenterol ; 58(8): 778-784, 2020 Aug.
Artículo en Alemán | MEDLINE | ID: mdl-32785914

RESUMEN

Clostridioides difficile infections (CDI) are typical antibiotic therapy associated complications. Notwithstanding the fact that the clinical picture of CDI may extend to the development of a toxic megacolon with potentially life-threatening sequelae, mild infectious forms associated with uncomplicated diarrhoea are by far the most prevalent and should also be treated according to clear clinical practice guidelines. However, there are currently conflicting international guidelines governing metronidazole-based treatment of mild infections. In light of this shortcoming, we performed a selective literature search of guidelines and clinical studies relating to the use of metronidazole for mild CDIs. The evaluation of randomised controlled trials demonstrates that, in statistical terms, vancomycin is significantly superior to metronidazole (NNT 16). When large cohort studies are included, this difference in effectiveness is reduced to 2,5 % (NNT 40). Inconsistent criteria for defining a mild CDI, different doses, applications and time intervals (e. g. additional IV administration of metronidazole) and the retrospective nature of some studies make it difficult to identify the influence of possible interference variables in this evaluation. Nevertheless, a mild CDI can be successfully treated with metronidazole; other recommendations, particularly those of American associations, should be evaluated critically. It is important to note that this therapy recommendation does not apply to patients with chronic inflammatory bowel diseases or other patients with pertinent comorbidities.


Asunto(s)
Antibacterianos/uso terapéutico , Metronidazol/uso terapéutico , /aislamiento & purificación , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Resultado del Tratamiento , Vancomicina/uso terapéutico
17.
Cochrane Database Syst Rev ; 8: CD012328, 2020 08 03.
Artículo en Inglés | MEDLINE | ID: mdl-32746500

RESUMEN

BACKGROUND: About half of patients with Crohn's disease (CD) require surgery within 10 years of diagnosis. Resection of the affected segment is highly effective, however the majority of patients experience clinical recurrence after surgery. Most of these patients have asymptomatic endoscopic recurrence weeks or months before starting with symptoms. This inflammation can be detected by colonoscopy and is a good predictor of poor prognosis.Therapy guided by colonoscopy could tailor the management and improve the prognosis of postoperative CD. OBJECTIVES: To assess the effects of prophylactic therapy guided by colonoscopy in reducing the postoperative recurrence of CD in adults. SEARCH METHODS: The following electronic databases were searched up to 17 December 2019: MEDLINE, Embase, CENTRAL, Clinical Trials.gov, WHO Trial Registry and Cochrane IBD specialized register. Reference lists of included articles, as well as conference proceedings were handsearched. SELECTION CRITERIA: Randomised controlled trials (RCTs), quasi-RCTs and cohort studies comparing colonoscopy-guided management versus management non-guided by colonoscopy. DATA COLLECTION AND ANALYSIS: Two review authors independently considered studies for eligibility, extracted the data and assessed study quality. Methodological quality was assessed using both the Cochrane 'Risk of bias' tool for RCTs and Newcastle-Ottawa scale (NOS) for cohort studies. The primary outcome was clinical recurrence. Secondary outcomes included: endoscopic, surgical recurrence and adverse events. We calculated the risk ratio (RR) for each dichotomous outcome and extracted the hazard ratio (HR) for time-to-event outcomes. All estimates were reported with their corresponding 95% confidence interval (CI). Data were analysed on an intention-to-treat (ITT) basis. The overall quality of the evidence was evaluated using GRADE criteria. MAIN RESULTS: Two RCTs (237 participants) and five cohort studies (794 participants) met the inclusion criteria. Meta-analysis was not conducted as the studies were highly heterogeneous. We included two comparisons. Intensification of prophylactic-therapy guided by colonoscopy versus intensification guided by clinical recurrence One unblinded RCT and four retrospective cohort studies addressed this comparison. All participants received the same prophylactic therapy immediately after surgery. In the colonoscopy-based management group the therapy was intensified in case of endoscopic recurrence; in the control group the therapy was intensified only in case of symptoms. In the RCT, clinical recurrence (defined as Crohn's Disease Activity Index (CDAI) > 150 points) in the colonoscopy-based management group was 37.7% (46/122) compared to 46.1% (21/52) in the control group at 18 months' follow up (RR 0.82, 95% CI: 0.56 to 1.18, 174 participants, low-certainty evidence). There may be a reduction in endoscopic recurrence at 18 months with colonoscopy-based management (RR 0.73, 95% CI 0.56 to 0.95, 1 RCT, 174 participants, low-certainty evidence). The certainty of the evidence for surgical recurrence was very low, due to only four cohort studies with inconsistent results reporting this outcome. Adverse events at 18 months were similar in both groups, with 82% in the intervention group (100/122) and 86.5% in the control group (45/52) (RR 0.95, 95% CI:0.83 to 1.08, 1 RCT, 174 participants, low-certainty of evidence).The most common adverse events reported were alopecia, wound infection, sensory symptoms, systemic lupus, vasculitis and severe injection site reaction. Perforations or haemorrhages secondary to colonoscopy were not reported. Initiation of prophylactic-therapy guided by colonoscopy versus initiation immediately after surgery An unblinded RCT and two retrospective cohort studies addressed this comparison. The control group received prophylactic therapy immediately after surgery, and in the colonoscopy-based management group the therapy was delayed up to detection of endoscopic recurrence. The effects on clinical and endoscopic recurrence are uncertain (clinical recurrence until week 102: RR 1.16, 95% CI 0.73 to 1.84; endoscopic recurrence at week 102: RR 1.16, 95% CI 0.73 to 1.84; 1 RCT, 63 participants, very low-certainty evidence). Results from one cohort study were similarly uncertain (median follow-up 32 months, 199 participants). The effects on surgical recurrence at a median follow-up of 50 to 55 months were also uncertain in one cohort study (RR 0.79, 95% CI 0.38 to 1.62, 133 participants, very low-certainty evidence). There were fewer adverse events with colonoscopy-based management (54.8% (17/31)) compared with the control group (93.8% (30/32)) but the evidence is very uncertain (RR 0.58, 95% CI 0.42 to 0.82; 1 RCT, 63 participants). Common adverse events were infections, gastrointestinal intolerance, leukopenia, pancreatitis and skin lesions. Perforations or haemorrhages secondary to colonoscopy were not reported. AUTHORS' CONCLUSIONS: Intensification of prophylactic-therapy guided by colonoscopy may reduce clinical and endoscopic postoperative recurrence of CD compared to intensification guided by symptoms, and there may be little or no difference in adverse effects. We are uncertain whether initiation of therapy guided by colonoscopy impacts postoperative recurrence and adverse events when compared to initiation immediately after surgery, as the certainty of the evidence is very low. Further studies are necessary to improve the certainty of the evidence of this review.


Asunto(s)
Colonoscopía , Enfermedad de Crohn/prevención & control , Enfermedad de Crohn/cirugía , Prevención Secundaria/métodos , Adalimumab/efectos adversos , Adalimumab/uso terapéutico , Adulto , Antibacterianos/uso terapéutico , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Enfermedades Asintomáticas , Azatioprina/efectos adversos , Azatioprina/uso terapéutico , Sesgo , Estudios de Cohortes , Enfermedad de Crohn/diagnóstico por imagen , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Mesalamina/efectos adversos , Mesalamina/uso terapéutico , Metronidazol/efectos adversos , Metronidazol/uso terapéutico , Purinas/efectos adversos , Purinas/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Estudios Retrospectivos , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores
18.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 55(7): 475-481, 2020 Jul 09.
Artículo en Chino | MEDLINE | ID: mdl-32634886

RESUMEN

Objective: To explore the effect of systemic use of amoxicillin and metronidazole during mechanical therapy on the clinical parameters of the first molars and periodontal microorganisms in subgingival plaque and saliva in patients with generalized aggressive periodontitis (GAgP). Methods: A total of 23 GAgP patients were recruited from Peking University School and Hospital of Stomatology from January 2006 to December 2009 and then randomly divided into two groups according to random number table: 12 patients received scaling and root planning (SRP) only and 11 patients received SRP combined with systemic administration of antibiotics (amoxicillin and metronidazole for a week after supragingival scaling). Clinical examination of periodontal parameters and collection of saliva and pooled subgingival plaque samples from mesial-buccal sites of 4 first molars were performed before initial therapy and 2, 4 and 6 months respectively after mechanical therapy, and saliva samples were also collected 2 weeks after therapy. Eight different periodontal microorganisms were detected in these samples by PCR. In addition, semiquantitative analysis of red complex microorganisms [Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td)] was performed. Results: Both therapies led to significant decrease of the plaque index (PLI), probing depth (PD) and bleeding index (BI) from mesial-buccal sites of first molars. Meanwhile the PD of antibiotics group [(4.21±1.50), (4.00±1.54), (3.84±1.89) mm of 2, 4 and 6 months respectively after therapy] was significantly lower than the SRP group [(5.29±1.27), (5.30±1.34), (4.98±1.36) mm of 2, 4 and 6 months respectively after therapy] at 3 different time points after mechanical therapy (P<0.05). In the antibiotics group, the quantities of Pg, Tf and Td in subgingival plaque samples (the median quantity decreased to 0.0 ng at 2, 4 and 6 months after therapy) and saliva samples (the median quantity of Tf and Td decreased to 0.0 ng at 2, 4 and 6 months after therapy (P<0.05), and the median quantity of Pg decreased to 16.3, 59.6 and 22.4 ng at 2, 4 and 6 months respectively after therapy) significantly decreased at 3 different time points after mechanical therapy compared with before therapy (P<0.05). While in the SRP group, there were no significant changes in the quantities of Tf and Td in saliva at 2, 4 and 6 months after mechanical therapy (P>0.05) , and the quantities of Tf and Td in subgingival plaque significantly decreased only at 2 months after therapy (P<0.05). Conclusions: SRP combined with systemic administration of amoxicillin and metronidazole could achieve greater improvement in PD of first molars and better control of the amounts of red complex microorganisms in the saliva and subgingival plaque of GAgP patients over a 6-month period.


Asunto(s)
Periodontitis Agresiva/terapia , Placa Dental , Amoxicilina/uso terapéutico , Antibacterianos/uso terapéutico , Raspado Dental , Humanos , Metronidazol/uso terapéutico , Saliva
19.
J Int Acad Periodontol ; 22(3): 129-136, 2020 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-32655038

RESUMEN

AIMS: This case series study aimed to assess the clinical outcomes of a novel protocol for the treatment of patients with severe periodontitis. MATERIALS AND METHODS: Twenty (20) patients with severe periodontitis underwent a single session of One-Stage Full-Mouth Instrumentation (OSFMI) involving supra- and sub-gingival air-polishing with erythritol and chlorhexidine powder and ultrasonic root surface debridement and calculus removal, in association with systemic amoxicillin and metronidazole. Pocket Probing Depth (PPD), Clinical Attachment Level (CAL), Recession (REC), Bleeding on Probing (BOP) and Plaque Index (PI) were collected at baseline (T0), 6 weeks (T1), 3 months (T2) and 6 months (T3). RESULTS: At 6 months, 30% of subjects reached the primary clinical endpoint (less than or equal to4 sites with PD greater than or equal to 5 mm). The percentage of BOP decreased from 49.08 (CI95% 36.06; 62.1) at T0 to 12.97 (CI95% 7.57; 18.37) at T3. The mean number pockets with PPD≥ 5 mm and PPD greater than or equal to 7 mm decreased significantly, from 46.0 and 20.6 at T0 to 11.5 and 2.8 at T3 respectively (p less than 0.001). CONCLUSION: The OSFMI protocol led to clinical results comparable to those obtained with traditional SRP. Researchers are encouraged to test this protocol in randomized clinical trials with longer periods of observation.


Asunto(s)
Raspado Dental , Periodontitis , Índice de Placa Dental , Humanos , Metronidazol/uso terapéutico , Bolsa Periodontal/terapia , Periodontitis/terapia , Resultado del Tratamiento
20.
BMC Infect Dis ; 20(1): 491, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-32650729

RESUMEN

BACKGROUND: Bacterial vaginosis (BV) increases HIV risk and adverse reproductive outcomes. Standard-of-care (SOC) for BV are antibiotics; however, cure rates are low. Probiotics for vaginal health may be useful in improving cure and recurrence although the regulatory framework governing probiotics and the conduct of randomized clinical trials to evaluate these has not been established in South Africa. We performed an exploratory single-blind trial evaluating a commercial oral-vaginal-combination probiotic as adjunct to SOC for BV treatment. METHODS: Women with symptomatic vaginal discharge were screened for BV and common sexually transmitted infections (STIs). BV+ (Nugent 7-10) but STI- women were randomized to vaginal metronidazole alone (n = 12) or to metronidazole followed by a commercial oral/vaginal probiotic (n = 18). The primary qualitative outcome was to test the regulatory landscape for conducting randomized probiotic trials in South Africa; and acceptability of vaginal application by women. BV cure at 1 month (Nugent≤3) was the primary quantitative endpoint. Secondary quantitative endpoints were BV recurrence, symptoms, vaginal microbiota and genital cytokine changes over 5 months post-treatment. RESULTS: The  South African Health Products Regulatory Authority (SAHPRA) reviewed and approved this trial. As probiotics continue to be regulated as health supplements in South Africa, SAHPRA required a notification application for this trial. Acceptability and adherence to the oral and vaginal application of the probiotic were high, although women reported a preference for oral capsules. 44.8% of women cleared BV one-month post-treatment, and no significant differences in BV cure (RR = 0.52, 95% CI = 0.24-1.16), recurrence, vaginal pH, symptoms, microbiota or vaginal IL-1α concentrations were found between SOC and intervention groups in this pilot study with an over-the-counter product. CONCLUSION: Navigation of the SAHPRA registration process for evaluating a commercial probiotic in a randomised trial laid the foundation for planned larger trials of improved probiotic products for vaginal health in South Africa. Although adherence to the vaginally delivered probiotic was high, women preferred oral application and we recommend that improvements in the content and method of application for future probiotics for vaginal health should be considered. TRIAL REGISTRATION: This trial was registered on 17 October 2017 with the South African National Clinical Trial Register ( http://www.sanctr.gov.za/ ; BV-trial1; DOH-27-1117-5579 ).


Asunto(s)
Probióticos/uso terapéutico , Vaginosis Bacteriana/microbiología , Vaginosis Bacteriana/terapia , Administración Intravaginal , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Suplementos Dietéticos , Aprobación de Drogas , Femenino , Humanos , Interleucina-1alfa/metabolismo , Cumplimiento de la Medicación , Metronidazol/administración & dosificación , Metronidazol/uso terapéutico , Microbiota , Proyectos Piloto , Recurrencia , Método Simple Ciego , Sudáfrica , Resultado del Tratamiento , Adulto Joven
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