Frontiers of rapid itch relief: a review of methylprednisolone aceponate.

In a paediatric population, the successful management of childhood atopic dermatitis (AD) should include the careful evaluation and selection of available therapies, based not only on demonstrated safety and tolerability in small children and infants, but also on their evidence-based, anti-pruritic benefits. Moreover, the speed of anti-pruritic effect should be considered a significant parameter in treatment selection. The fourth-generation topical corticosteroid (TC) methylprednisolone aceponate (MPA) is a potent anti-inflammatory agent with a demonstrated fast and effective itch relief profile in children and infants (as young as 2 months) with AD. Compared with traditional TCs, MPA has a significantly improved therapeutic index; that is, increased potency without a proportionate increase in side effects. In addition to its established efficacy, the once-daily application and broad range of available formulations make MPA an optimal choice for acute and maintenance therapy in paediatric patients with AD-related pruritus.

Prevalencia de portadores faríngeos de 'Streptococcus pyogenes' en escolares de la Comunidad Valenciana / Prevalence of pharyngeal carriage os "Streptococcus pyogenes" among elementary school children in the Community of Valencia, Spain

Objetivo: Determinar la prevalencia de portadores de estreptococo betahemolítico del grupo A (EBHGA) en niños escolares de la Comunidad Valenciana al comienzo del in-vierno.Material y métodos: Estudio transversal. Se aleatorizaron 36 aulas escolares (clusters), de 1.° a 6.° de EGB de 50 colegios de las provincias de Valencia y Castellón, y se obtuvo un exudado faríngeo en al menos 7 niños sanos de cada aula que no habían recibido antibioticoterapia en los 10 días previos. Las torundas se sembraron en agar sangre y las colonias betahemolíticas crecidas fueron identificadas como EBHGA mediante las pruebas de sensibilidad a bacitracina y aglutinación con un antisuero específico adsorbido a partículas de látex. Resultados: Se obtuvieron 252 muestras de exudado faríngeo, de las que se aisló EBHGA en 4 casos (1,6 por ciento; IC 95 por ciento: 0,60-3,85 por ciento). No se produjo más de un caso en una misma aula. Conclusiones: La prevalencia de portadores de EBHGA en escolares, en una muestra representativa de la Comunidad Valenciana, es menor de la descrita en otros estudios (AU)

[Sensitivity of group A beta-hemolytic Streptococcus isolated from pediatric pharyngotonsillitis to erythromycin and clarithromycin: a primary care multicenter study]. / Sensibilidad a eritromicina y claritromicina de aislados de Streptococcus betahemolítico del grupo A productores de faringoamigdalitis en la edad pediátrica: estudio multicéntrico en atención primaria. Grupo Español para el Estudio de la Sensibilidad a Macrólidos en Atención Primaria.

BACKGROUND: The recent increase in the prevalence of macrolide-resistant group A beta-haemolytic Streptococcus (BHSGA) strains reported in some areas in Spain and several neighboring countries underscores the need to perform a periodic surveillance, with the adequate methodology, of the level of its susceptibility to these antimicrobials which are frequently used in our country for the treatment of acute streptococcal pharingotonsillitis and respiratory tract infections. PATIENTS AND METHODS: The susceptibility of 293 isolates of BHSGA to the macrolides erythromycin and clarithromycin was evaluated by the broth microdilution procedure recommended by the NCCLS (1997). The isolates were prospectively obtained from children with acute pharyngotonsillitis (n = 757) who were seen at primary care centers in ten Spanish cities. RESULTS: An overall prevalence of 8.9 and 7.8% erythromycin- and clarithromycin-resistant BHSGA isolates was respectively found. The percentage of resistant isolates varied considerably among the different cities subjected to study (0-33%). Overall, the intrinsic activity of clarithromycin (MIC50 and MIC90 of 0.007 and 0.25 mg/ml, respectively) was slightly higher than that of erythromycin (MIC50 and MIC90 of 0.015 and 0.5 mg/ml, respectively). All strains studied were uniformly susceptible to penicillin. CONCLUSIONS: Macrolide antibiotics, erythromycin and clarithromycin, continue to be highly active against BHSGA. The mean level of resistant strains found in Spain from community acquired infections and recovered prospectively is comparable to that of our neighboring countries.

Cost-effectiveness analysis of different strategies for treating duodenal ulcer. Helicobacter pylori eradication versus antisecretory treatment.

Helicobacter pylori has recently been recognised as a causative agent for duodenal ulcer, and the efficacy of various combinations of antibacterials and antisecretory agents in eradicating this pathogen has been assessed. The objective of this study was to determine the efficiency of 2 treatment strategies for patients with H. pylori-positive duodenal ulcer. Cost effectiveness was analysed for antisecretory therapy (omeprazole 20 mg/day for 4 weeks), and eradication therapy (triple therapy: omeprazole 40 mg/day plus clarithromycin 1 g/day plus amoxicillin 2 g/day for 1 week). In a Markov model, a hypothetical cohort of 5000 patients was followed for 10 years through 6 disease states. Cyclic eradication therapy (i.e. in the first duodenal ulcer episode and in relapses) was the most cost effective [21 Spanish pesetas (Pta) per day free of symptoms (DFS); Pta128 = $US1 (October 1995)] of the eradication options evaluated [antisecretory in the first episode, then eradication for relapses (Pta22.3/DFS), and eradication therapy first, then antisecretory therapy (Pta27.3/DFS)]. Antisecretory therapy alone was less cost-effective (Pta39/DFS) than each of the 3 eradication options. Eradication treatment in the first episode of duodenal ulcer and relapses has savings in direct costs per patient of up to 56% compared with antisecretory therapy alone. Sensitivity analyses showed the model to be very robust. It is, therefore, advisable to treat initial episodes of H. pylori-positive duodenal ulcer and relapses with triple therapy. The improved cost-effectiveness ratio was largely explained by the long term reduction in relapses obtained with the eradication strategies.

Antimicrobial susceptibility of Streptococcus pneumoniae isolated from pediatric carriers in Spain.

The in vitro activity of several beta-lactam agents, macrolides, and cotrimoxazole was investigated against 53 Streptococcus pneumoniae isolates recovered from healthy children. The rates of resistance to penicillin or amoxicillin, cefaclor, and cefuroxime were 30%, 51%, and 37%, respectively. No cefotaxime-resistant isolates were found. Rates of resistance to erythromycin, clarithromycin, and cotrimoxazole were 22.6%, 13.2%, and 83%, respectively. Pneumococci with divergent antimicrobial susceptibility profiles (susceptible or moderately resistant vs. resistant isolates) coexisted in 32% samples, with divergencies more often involving beta-lactam agents and/or macrolides. In five of these samples, isolates belonged to different serotypes.