Tratamiento de la amigdalitis estreptocócica con amoxicilina una vez al día: metaanálisis / Treatment of streptococcal tonsillitis with once-a-day amoxicillin: a meta-analysis

Introducción: El objetivo de la presente revisión sistemática es determinar si el tratamiento antibiótico de la faringoamigdalitis estreptocócica con una dosis diaria de amoxicilina tiene una eficacia similar a otras posologías (cada 8 o 12h) del mismo antibiótico o de penicilina V. Material y métodos: Se incluyeron ensayos clínicos aleatorios (ECA), que compararan amoxicilina (1 dosis/día) frente a otras posologías de amoxicilina (cada 8-12h) o penicilina V (cada 6, 8 o 12h). Bases de datos y buscadores consultados: Medline, Central, EMBASE y Google Académico. Los resultados se combinaron estimándose la diferencia de riesgos ponderada (DR). Se midió la eficacia del tratamiento por la negativización de cultivo orofaríngeo previamente positivo a estreptococo del grupo A a los 14-21 días (bajo una hipótesis de no inferioridad, considerando como tal que el límite superior del intervalo de confianza del 95% [IC del 95%] de la DR no supere el 10%) y la recaída clínica a los 10-21 días. Los resultados se combinaron siguiendo un modelo de efectos fijos o aleatorios según existiera o no heterogeneidad. Resultados: Cumplieron los criterios de selección 4 ECA con 1.314 participantes (657 recibieron amoxicilina 1 vez/día y 657 otros antibióticos o posologías): a) cultivo positivo para cualquier estreptococo (14-21 días, 4 ECA): DR: –0,5% (IC del 95%, –5,1% a 4,2%; b) persistencia del mismo serotipo (14-21 días, 3 ECA): DR: 0,32% (IC del 95%, –3,1% a 3,7%; c) recaída clínica (10-21 días, 2 ECA): DR: 1,7% (IC del 95%, –1,9% a 5,4%); d) efectos adversos (4 ECA): DR: –0,39% (IC del 95%, –1,5% a 6,8%(. No existieron diferencias estadísticamente significativas en ninguna de las comparaciones realizadas. Conclusiones: La amoxicilina, administrada en una sola dosis diaria, no es inferior a otras posologías del mismo antibiótico o de penicilina V. Estos resultados son importantes ya que pueden facilitar el cumplimiento terapéutico (AU)

Introduction: The objective of this systematic review is to determine if the treatment of streptococcal pharyngitis with a daily dose of amoxicillin is similar in effectiveness to other dosing schedules (every 6, 8 or 12hours) of the same antibiotic or penicillin V. Material and methods: Randomised clinical trials (RCT) comparing amoxicillin (one dose per day) compared to other dosages of amoxicillin (every 8-12hours) or penicillin V (every 6, 8 or 12hours). Search databases consulted: Medline, Central, EMBASE and Google Scholar. The results were combined using the risk difference (RD). We measured the effectiveness of each treatment with a negative throat culture on the 14-21th day, being previously positive to group A Streptococcus (under a non-inferiority hypothesis, where the upper limit of the 95% confidence interval [95% CI] of the DR does not exceed 10%) and clinical failure on days 10-21. The results were combined according to a fixed effects model or random depending on whether or not there was heterogeneity. Results: Four RCT met the selection criteria with 1,314 participants (657 received amoxicillin once per day, and 657 received other antibiotics or dosages): a) any positive culture for Streptococcus (14-21st day, 4 RCTs): DR: –0.5% (95% CI: –5.1% to 4.2%; b) persistence of the same serotype (14-21st day, 3 RCT): DR: 0.32% (95% CI: –3.1% to 3.7%; c) clinical failure (2 RCT): DR: 1.7% (95% CI: –1.9% to 5.4%; d) adverse effects (4 RCT): DR: –0.39% (95% CI: –1.5% to 6.8%). There were no statistically significant differences in any comparisons. Conclusions: Amoxicillin, administered once daily is not inferior to other dosages of the same antibiotic or penicillin V. These results are important because they may facilitate compliance (AU)

[Treatment of streptococcal tonsillitis with once-a-day amoxicillin: a meta-analysis]. / Tratamiento de la amigdalitis estreptocócica con amoxicilina una vez al día: metaanálisis.

INTRODUCTION: The objective of this systematic review is to determine if the treatment of streptococcal pharyngitis with a daily dose of amoxicillin is similar in effectiveness to other dosing schedules (every 6, 8 or 12 hours) of the same antibiotic or penicillin V. MATERIAL AND METHODS: Randomised clinical trials (RCT) comparing amoxicillin (one dose per day) compared to other dosages of amoxicillin (every 8-12 hours) or penicillin V (every 6, 8 or 12 hours). Search databases consulted: Medline, Central, EMBASE and Google Scholar. The results were combined using the risk difference (RD). We measured the effectiveness of each treatment with a negative throat culture on the 14-21th day, being previously positive to group A Streptococcus (under a non-inferiority hypothesis, where the upper limit of the 95% confidence interval [95% CI] of the DR does not exceed 10%) and clinical failure on days 10-21. The results were combined according to a fixed effects model or random depending on whether or not there was heterogeneity. RESULTS: Four RCT met the selection criteria with 1,314 participants (657 received amoxicillin once per day, and 657 received other antibiotics or dosages): a) any positive culture for Streptococcus (14-21st day, 4 RCTs): DR: -0.5% (95% CI: -5.1% to 4.2%; b) persistence of the same serotype (14-21st day, 3 RCT): DR: 0.32% (95% CI: -3.1% to 3.7%; c) clinical failure (2 RCT): DR: 1.7% (95% CI: -1.9% to 5.4%; d) adverse effects (4 RCT): DR: -0.39% (95% CI: -1.5% to 6.8%). There were no statistically significant differences in any comparisons. CONCLUSIONS: Amoxicillin, administered once daily is not inferior to other dosages of the same antibiotic or penicillin V. These results are important because they may facilitate compliance.

Del síntoma a la enfermedad. Presentación / From the symptom to the disease. Presentation

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[Antibiotic use in primary care. Do we know what parents think?]. / Utilización adecuada de antibióticos en atención primaria: sabemos qué piensan los padres?

INTRODUCTION: In Spain, studies that investigate parents' beliefs on antibiotic use are lacking. Mistaken beliefs lead to inappropriate antibiotic use and encourage overuse. The aim of the present study was to determine parents' knowledge about antibiotic use. MATERIAL AND METHODS: We performed a cross sectional, descriptive study in two health centers through a self-administered questionnaire completed by 348 parents. The response variable consisted of beliefs evaluated when the parents answered the following three statements in the affirmative: a) there are currently some infections with inadequate response to antibiotic treatment; b) if antibiotics are used too often, they can cease to have an effect; c) if your child frequently receives antibiotic treatment, subsequent use may have no effect. Independent variables consisted of sex of the responder, educational level, parental age and ethnicity, attendance at school (public or private), attendance at kindergarten, usual healthcare (public-private), and number of siblings. Statistical analysis consisted of logistic regression. RESULTS: A total of 31.6 % (95 % CI: 26.7-36.5) responded affirmatively to the three statements. Adequate knowledge was associated with the non-immigrant population (OR: 5.7; 95 % CI: 1.37-24.9) and high parental education (OR: 2.04; 95 % CI: 1.16-3.06). CONCLUSIONS: Parents' knowledge of antibiotic use is low compared with that in other countries. Health education programs to remedy this situation are urgently required.

Utilización adecuada de antibióticos en atención primaria: ¿sabemos qué piensan los padres? / Antibiotic use in primary care. Do we know what parents think?

Introducción: En España no existen estudios que investiguen las creencias de los padres sobre el uso de antibióticos. Las creencias erróneas determinan el uso inadecuado de antimicrobianos, propiciando su sobreutilización. El objetivo del presente estudio es determinar el nivel de conocimientos de los padres sobre la utilización de los antibióticos. Material y métodos: Estudio descriptivo transversal realizado en dos centros de salud (encuesta autocumplimentada por 348 padres).Creencias valoradas cuando los padres contestaron afirmativamente a tres frases (variable de respuesta): a) actualmente existen algunas infecciones que no responden adecuadamente al tratamiento con antibióticos; b) si los antibióticos se utilizan con demasiada frecuencia, es posible que dejen de hacer efecto; c) si tu hijo recibe con frecuencia tratamiento con antibióticos, es posible que cuando los vuelva a necesitar no le hagan efecto. Variables independientes: sexo de la persona que respondió la encuesta, nivel de estudios, edad y etnia de los padres, asistencia a colegio (público o privado), asistencia a guardería, asistencia médica habitual (pública-privada), número de hermanos. Como prueba estadística se aplicó la regresión logística. Resultados: El 31,6 por ciento (intervalo de confianza del 95 por ciento [IC 95 por ciento], 26,7-36,5) respondió de forma afirmativa a las tres frases. Un nivel adecuado de creencias se asoció con población no inmigrante (odds ratio [OR], 5,7; IC 95 por ciento, 1,37-24,9) y nivel elevado de estudios de los padres (OR, 2,04; IC 95 por ciento, 1,16-3,06). Conclusiones: El nivel de conocimientos es bajo comparado con otros países. Urge la puesta en marcha de programas de educación sanitaria que corrijan esta situación (AU)

[Is general screening for anemia and iron deficiency justified in nursing infants?]. / Está justificado el cribado generalizado de anemia y ferropenia en los lactantes?

OBJECTIVE: To establish the necessity of anemia and iron deficiency screening in breast-feeders in our environment. DESIGN: A crossover study, after data collection from case records. SETTING AND PATIENTS: 93 children of 18 and 24 months living in a urban area. All of them are included in the Healthy Breast-feeder Programme of the Health Center of Teruel city. INTERVENTIONS: Detection in venous blood of hematocrit, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, transferrin saturation and ferritin in serum. MEASUREMENTS AND MAIN RESULTS: We founded a 1.1% of anemia with iron deficiency and a 3.4% of latent iron deficiency. We detected a total of 5.4% cases of iron deficiency. We didn't find any statistical significance when comparing the haematic values among children who had received different kinds of milk nor in relation with the time in which they got it. We didn't find either any differences when comparing such values among those who had received iron prophylaxis and those in which this treatment was not considered necessary. CONCLUSIONS: Therefore we suggest selective iron prophylaxis for risk groups and laboratory studies only in those with evident signs of anemia or iron deficiency.