Efficacy and safety of withholding antimicrobial treatment in children with cancer, fever and neutropenia, with a demonstrated viral respiratory infection: a randomized clinical trial.

OBJECTIVES: To determine efficacy and safety of withholding antimicrobials in children with cancer, fever and neutropenia (FN) with a demonstrated respiratory viral infection. METHODS: Prospective, multicentre, randomized study in children presenting with FN at five hospitals in Santiago, Chile, evaluated at admission for diagnosis of bacterial and viral pathogens including PCR-microarray for 17 respiratory viruses. Children positive for a respiratory virus, negative for a bacterial pathogen and with a favourable evolution after 48 h of antimicrobial therapy were randomized to either maintain or withhold antimicrobials. Primary endpoint was percentage of episodes with uneventful resolution. Secondary endpoints were days of fever/hospitalization, bacterial infection, sepsis, admission to paediatric intensive care unit (PICU) and death. RESULTS: A total of 319 of 951 children with FN episodes recruited between July 2012 and December 2015 had a respiratory virus as a unique identified microorganism, of which 176 were randomized, 92 to maintain antimicrobials and 84 to withdraw. Median duration of antimicrobial use was 7 days (range 7-9 days) versus 3 days (range 3-4 days), with similar frequency of uneventful resolution (89/92 (97%) and 80/84 (95%), respectively, not significant; OR 1.48; 95% CI 0.32-6.83, p 0.61), and similar number of days of fever (2 versus 1), days of hospitalization (6 versus 6) and bacterial infections throughout the episode (2%-1%), with one case of sepsis requiring admission to PICU in the group that maintained antimicrobials, without any deaths. CONCLUSIONS: The reduction of antimicrobials in children with FN and respiratory viral infections, based on clinical and microbiological/molecular diagnostic criteria, should favour the adoption of evidence-based management strategies in this population.

Prospective evaluation of a model of prediction of invasive bacterial infection risk among children with cancer, fever, and neutropenia.

A risk prediction model for invasive bacterial infection (IBI) was prospectively evaluated among children presenting with cancer, fever, and neutropenia. The model incorporated assessment of 5 previously identified risk factors: serum level of C-reactive protein (CRP) >/=90 mg/L, hypotension, identification of relapse of leukemia as the cancer type, platelet count of

Tratamiento esteroidal en distrofia muscular de Duchenne. / Steroid treatment in Duchenne's muscular dystrophy

Ocho pacientes con distrofia muscular de Duchenne, diagnosticados por las manifestaciones clinicas, biopsia muscular, creatinfosfokinasa (CPK) y electromiografia, de edades entre 5 anos 1/12 y 11 anos 5/12, fueron tratados con prednisona (Laboratorio Chile) 3 mg por Kg de peso, en dias alternos, durante un periodo de un ano. Los pacientes no habian perdido la deambulacion. El seguimiento se realizo con medicion de fuerza muscular,actividad fisica, niveles de CPK y electromielografia. Este grupo de enfermos se compara al termino del tratamiento con un grupo de ninos portadores de DMD de edades similares que no recibieron tratamiento esteroidal. Los resultados muestran una significativa mejoria (P < 0,010), en fuerza muscular (medido por Score Muscular Total) y actividad fisica (P < 0,001) a los 6 meses de tratamiento. Al ano de tratamiento no hay diferencia significativa en ambos parametros con respecto al estado inicial. No se observaron diferencias en fuerza muscular y actividad fisica al ano de tratamiento con respecto al grupo sin tratamiento. Los valores de CPK no mostraron diferencias significativas respecto a los valores iniciales. La electromiografia no mostro variaciones significativas en el curso del tratamiento. Aunque el numero de paciente es reducido, nuestra experiencia muestra que los corticoides no tienen efectos beneficos en la evolucion clinica de la DMD