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.

El papel de la antibioterapia en la sinusitis aguda: revisión sistemática y metaanálisis / The role of antibiotics in acute sinusitis: a systematic review and metaanalysis

Introducción: El objetivo fue determinar si los antibióticos son más eficaces que el placebo o ninguna intervención en el tratamiento de la sinusitis aguda. Pacientes y métodos: Se revisaron las bases de datos y buscadores: PubMed, EMBASE, Cochrane Central Register of Controlled Trials y Google Académico para identificar ensayos clínicos aleatorizados (ECA) realizados en niños que compararan antibiótico frente a placebo. Se consideró sinusitis, la persistencia de sintomatología clínica compatible durante al menos 10 días. La calidad metodológica se evaluó mediante la escala de Jadad. Fueron seleccionados 4 ECA. Se evaluaron las siguientes variables: curación-mejoría clínica (a día 10-14), recaídas-recurrencias (a día 14-60) y presencia de efectos adversos. Los resultados se combinaron mediante metaanálisis. Se adoptó un análisis según modelo de efectos fijos o aleatorios en función de si existía o no heterogeneidad. El parámetro combinado que se estimó fue el riesgo relativo (RR) y su intervalo de confianza del 95% (IC 95%). Resultados: Dos ECA tenían una puntuación en la escala de Jadad ≥ 3. Variable curación-mejoría (4 ECA): RR: 1,11 (IC 95%: 0,9 a 1,3). Variable recaída-recurrencia (3 ECA): RR: 0,9 (IC 95%: 0,6 a 1,5); efectos adversos (4 ECA): 2,01 (IC 95%: 1,1 a 3,8). Conclusiones: En niños con sinusitis aguda, el tratamiento antibiótico a las dosis estudiadas no parece aportar beneficio alguno en cuanto a la curación-mejoría evaluada al 10-14 día de seguimiento. El porcentaje de recaídas-recurrencias no fue inferior entre los niños que recibieron antibiótico. Los antibióticos se asocian con mayor probabilidad a efectos adversos (AU)

Introduction: The aim of this systematic review is to assess whether antibacterial agents are more effective than either placebo or no intervention at all in the treatment of acute bacterial sinusitis. Patients and methods: We reviewed the databases and search engines: PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Google Scholar to identify randomized clinical trials (RCTs) in children comparing antibiotics versus placebo. Sinusitis was considered as the persistence of clinically compatible symptoms for at least 10 days. The methodological quality was assessed using the Jadad scale. Four RCTs were selected. We studied the following variables: cure, clinical improvement (on days 10 to 14), relapse-recurrence (from day 14 to day 60) and presence of adverse effects. The results were combined using meta-analysis. We used the fixed effects model or random model depending on whether or not there was heterogeneity. We estimated the combined relative risk (RR) and 95% confidence interval. Results: Only two RCTs had a Jadad scale score ≥3. Variable cure-improvement (4 RCTs): RR 1.11 (95% CI: 0.9 to 1.3). Variable relapse-recurrence (3 RCTs): RR 0.9 (95% CI: 0.6 to 1.5). Adverse effects (4 RCTs): 2.01 (95% CI 1.1 to 3.8). Conclusions: In children with acute sinusitis, antibacterial agents at the studied doses did not appear to provide benefit in terms of cure and improvement, assessed at 10 to 14 days of follow up. Similarly, the percentage of relapse-recurrence was not lower among children who received antibiotics. Antibiotics are associated more frequently with adverse effects( AU)

[The role of antibiotics in acute sinusitis: a systematic review and meta-analysis]. / El papel de la antibioterapia en la sinusitis aguda: revisión sistemática y metaanálisis.

INTRODUCTION: The aim of this systematic review is to assess whether antibacterial agents are more effective than either placebo or no intervention at all in the treatment of acute bacterial sinusitis. PATIENTS AND METHODS: We reviewed the databases and search engines: PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Google Scholar to identify randomized clinical trials (RCTs) in children comparing antibiotics versus placebo. Sinusitis was considered as the persistence of clinically compatible symptoms for at least 10 days. The methodological quality was assessed using the Jadad scale. Four RCTs were selected. We studied the following variables: cure, clinical improvement (on days 10 to 14), relapse-recurrence (from day 14 to day 60) and presence of adverse effects. The results were combined using meta-analysis. We used the fixed effects model or random model depending on whether or not there was heterogeneity. We estimated the combined relative risk (RR) and 95% confidence interval. RESULTS: Only two RCTs had a Jadad scale score ≥3. Variable cure-improvement (4 RCTs): RR 1.11 (95% CI: 0.9 to 1.3). Variable relapse-recurrence (3 RCTs): RR 0.9 (95% CI: 0.6 to 1.5). Adverse effects (4 RCTs): 2.01 (95% CI 1.1 to 3.8). CONCLUSIONS: In children with acute sinusitis, antibacterial agents at the studied doses did not appear to provide benefit in terms of cure and improvement, assessed at 10 to 14 days of follow up. Similarly, the percentage of relapse-recurrence was not lower among children who received antibiotics. Antibiotics are associated more frequently with adverse effects.

Anfotericina B liposomal y leishmaniasis visceral en un paciente inmunocompetente / Liposomal amphotericin B and visceral leishmaniasis in an immunocompetent patient

Presentamos el caso de un lactante de 19 meses, previamente sano, con antecedentes de vivir en una zona semirrural y de tener un perro como animal de compañía, que presentaba la clínica de fiebre de 2 semanas de evolución y esplenomegalia gigante. La pancitopenia y la hipergammaglobulinemia características de la enfermedad estaban presentes. En la biopsia de médula ósea no se detectó el parásito, pero la serología para Leishmania infantum resultó positiva. Se comenta la sensibilidad del aspirado de médula ósea en el diagnóstico. El paciente recibió tratamiento con anfotericina B liposomal, y la respuesta fue excelente. Este caso amplía la poca experiencia acumulada respecto al tratamiento de esta enfermedad con anfotericina B liposomal, en particular en niños menores de 2 años

We report the case of a previously healthy 19-month-old boy whose family lived in the countryside and had a dog. He presented with a two-week history of fever and massive splenomegaly. The characteristic pancytopenia and hypergammaglobulinemia were also detected. Bone marrow biopsy was negative, but serology was positive for Leishmania infantum. We point out the sensitivity of the bone marrow aspirate in the diagnosis. The child was treated with liposomal amphotericin B with an excellent response. This case broadens the limited cumulative experience in treating this disease with liposomal amphotericin B, in particular, in children less than two years old

Rotavirus y su papel en la génesis de convulsiones / Rotavirus and its role in the genesis of afebrile seizures

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[Sydenham's chorea: report of a case treated with carbamazepine with excellent clinical response]. / Corea de Sydenham: presentación de un caso tratado con carbamazepina con excelente respuesta clínica.

Sydenham's chorea is the most common cause of acquired chorea in childhood. This disorder is secondary to an autoimmune response against basal ganglia in the brain, induced by prior streptococcal infection. Chorea is a major criterion for the diagnosis of rheumatic fever and can also be the presenting feature of the disease. The incidence of rheumatic fever has been markedly decreased by improved socioeconomic conditions and increased antibiotic prescription. In the last two decades, however, this disease has reappeared and should be taken into account in the evaluation of children with movement disorders. Chorea is characterized by acute exacerbations that can cause substantial functional impairment and may warrant drug treatment. Carbamazepine has proven to be both efficacious and safe in the treatment of this condition. We present a case of rheumatic chorea, in which carbamazepine therapy produced excellent clinical response.

Corea de Sydenham: presentación de un caso tratado con carbamazepina con excelente respuesta clínica / Sydenham’s chorea: report of a case treated with carbamazepine with excellent clinical response

La corea de Sydenham es la causa más frecuente de corea adquirida en el niño. Se presenta por la existencia de una respuesta autoinmunitaria contra los núcleos de la base del cerebro, inducida tras una infección estreptocócica. La corea es uno de los criterios mayores de diagnóstico de fiebre reumática y puede ser la forma de presentación de esta entidad. La mejoría de las condiciones socioeconómicas y el tratamiento antibiótico han condicionado un descenso importante de la incidencia de fiebre reumática. En los últimos 20 años se ha producido un repunte de la enfermedad, que se ha de tener en cuenta en el diagnóstico diferencial de los trastornos del movimiento en la edad pediátrica. La corea evoluciona generalmente de forma subaguda con episodios de exacerbación que generan una importante repercusión funcional planteando la necesidad de un tratamiento farmacológico. Una de las posibilidades terapéuticas es la carbamazepina que se ha mostrado eficaz y segura en el tratamiento de esta entidad. Presentamos un caso de corea reumática que se trató con carbamazepina con una excelente respuesta clínica

Sydenham's chorea is the most common cause of acquired chorea in childhood. This disorder is secondary to an autoimmune response against basal ganglia in the brain, induced by prior streptococcal infection. Chorea is a major criterion for the diagnosis of rheumatic fever and can also be the presenting feature of the disease. The incidence of rheumatic fever has been markedly decreased by improved socioeconomic conditions and increased antibiotic prescription. In the last two decades, however, this disease has reappeared and should be taken into account in the evaluation of children with movement disorders. Chorea is characterized by acute exacerbations that can cause substantial functional impairment and may warrant drug treatment. Carbamazepine has proven to be both efficacious and safe in the treatment of this condition. We present a case of rheumatic chorea, in which carbamazepine therapy produced excellent clinical response