RESUMO
BACKGROUND: Leptospirosis poses a diagnostic challenge owing to its wide array of symptoms, ranging from asymptomatic cases and febrile syndromes to severe disease with a high mortality rate. Risk factors are associated with exposure and the immune response, particularly in immunosuppressed patients. CASE PRESENTATION: A clinical case involving a 49-year-old patient with a history of splenectomy and no immunization schedule. The patient presented to the emergency room with non-specific symptoms, primarily myalgias, arthralgias, and emesis, initially suggestive of a viral infection. However, there was a rapid progression to hypoxemic respiratory failure, requiring invasive ventilatory support. Given the immune status due to spleen absence, antibiotic treatment with meropenem and linezolid was promptly initiated, to mitigate the risk of post-splenectomy sepsis. During antibiotic administration, the patient experienced febrile episodes, accompanied by chills, myalgias, and emesis, which gradually decreased in both duration and intensity. Ultimately, the patient exhibited satisfactory progress, successfully underwent extubation, and completed a 7-day antibiotic course. Final reports confirmed positive IgM for Leptospira. CONCLUSION: Leptospirosis is a global zoonotic disease, displaying a diverse array of manifestations; recognized as a potential cause of undifferentiated fever, often confused with other prevalent tropical infections. The imperative to consider this diagnosis extends beyond the general population to encompass individuals in states of altered immunity. Recognizing and addressing leptospirosis in at-risk populations is crucial, as it can significantly impact the prompt initiation of treatment and, consequently, influence associated mortality rates.
Assuntos
Antibacterianos , Leptospirose , Humanos , Pessoa de Meia-Idade , Leptospirose/tratamento farmacológico , Leptospirose/complicações , Antibacterianos/uso terapêutico , Antibacterianos/efeitos adversos , Masculino , Esplenectomia , Leptospira/imunologiaRESUMO
INTRODUCTION: Water and electrolyte disturbances associated with colistin are understudied adverse effects in the medical literature. We aim to evaluate their incidence in hospitalized older adult patients. MATERIALS AND METHODS: A longitudinal retrospective study of the interrupted time series type was conducted on patients admitted to Dr. César Milstein Hospital. We included adults aged 65 and older who received colistin with normal serum potassium, magnesium, and calcium at the outset. Electrolyte values were collected before, during and after suspending the antibiotic. Values were compared using non-parametric tests, and a multivariate linear regression model with robust intervals was performed to assess sociodemographic and clinical characteristics associated with serum concentrations. RESULTS: A total of 89 patients were included. The rate of hypokalemia was 77.5% (n=69), and factors associated with potassium decline included older age, increased creatinine levels, and longer colistin treatment duration. Serum magnesium disturbances were reported in 66 (79.5%) of the 83 patients evaluated. The decrease in both electrolytes was statistically significant in the measured times and both values normalized after 72 hours of stopping antibiotic therapy. The incidence of acute kidney injury during colistin treatment in patients with normal baseline creatinine was 63.6% (n = 42/66), and in those with abnormal baseline creatinine, it was 47.8% (n = 11/23). CONCLUSION: We report high rates of electrolyte disturbances in patients treated with colistin, with hypokalemia being the most frequent, showing resolution following discontinuation of antibiotic therapy. Continuous monitoring of electrolyte levels and renal function during colistin treatment is crucial.
Introducción: Los trastornos hidroelectrolíticos asociados a la colistina son efectos adversos poco estudiados en la literatura médica. Nos propusimos evaluar su incidencia en pacientes adultos mayores hospitalizados. Materiales y métodos: Se realizó un estudio longitudinal retrospectivo, del tipo serie de tiempo interrumpida, en pacientes internados mayores de 65 años que recibieron colistina, con potasio, magnesio y calcio séricos normales al inicio. Se recabaron valores de dichos electrolitos previo, durante y luego de suspender el antibiótico. Se compararon los valores mediante test no paramétricos y se realizó un modelo multivariado de regresión lineal con intervalos robustos para evaluar las características sociodemográficas y clínicas asociadas a las concentraciones séricas. Resultados: Se incluyeron 89 pacientes. La tasa de hipocalemia fue del 77.5% (n = 69) y las variables asociadas al descenso del potasio fueron mayor edad, aumento de creatininemia, y duración de tratamiento con colistina. Se informaron trastornos del magnesio en 66 (79.5%) de los 83 pacientes evaluados. El descenso de ambos electrolitos fue estadísticamente significativo en los tiempos medidos, y ambos normalizaron valores tras 72 horas de suspendida la antibioticoterapia. La incidencia de insuficiencia renal aguda en pacientes con creatinina basal normal fue del 63.6%, (42/66) y con creatinina basal anormal de 47.8% (11/23). Conclusión: En pacientes tratados con colistina, el trastorno más frecuente fue la hipocalemia, mostrando resolución tras la suspensión del antibiótico. Es importante la monitorización constante de los niveles de electrolitos y la función renal durante el tratamiento con colistina.
Assuntos
Antibacterianos , Cálcio , Colistina , Hipopotassemia , Magnésio , Potássio , Humanos , Colistina/efeitos adversos , Colistina/sangue , Masculino , Feminino , Idoso , Estudos Retrospectivos , Magnésio/sangue , Antibacterianos/efeitos adversos , Hipopotassemia/sangue , Hipopotassemia/induzido quimicamente , Hipopotassemia/epidemiologia , Idoso de 80 Anos ou mais , Potássio/sangue , Cálcio/sangue , Estudos Longitudinais , Fatores de Tempo , Desequilíbrio Hidroeletrolítico/induzido quimicamente , Desequilíbrio Hidroeletrolítico/sangue , Desequilíbrio Hidroeletrolítico/epidemiologia , Injúria Renal Aguda/sangue , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/epidemiologiaRESUMO
Approximately 10% of the population reports being allergic to penicillin, although usually less than 1% really are. In addition, people with proven allergies over the years may no longer be allergic. Unconfirmed penicillin allergy and use of alternative antimicrobials result in more treatment failures; more severe adverse effects. Higher cost; longer hospitalizations; increase in the emergence of multi-resistant germs associated with health care. The risk of cross-allergy between ß-lactam groups is usually <2%, depending on the similarity of the side chains, so prescribing antibiotics from another ß-lactam group is safe as long as we take into account the structural similarity. Incorporating the reassessment of allergies and improving the prescription of antibiotics in this group of patients reduces the generation and spread of multi-resistant germs, and the associated costs. There are simple methods and specific scores that simplify allergy reassessment. The objective of this review is to expose how, through these methods, the delabeling of patients erroneously labeled as allergic and the safe prescription of ß-lactam antibiotics can be achieved.
Aproximadamente el 10% de la población refiere ser alérgico a la penicilina, aunque habitualmente menos del 1% lo es; además las personas con alergia demostrada con el paso de los años pueden dejar de ser alérgicos. La alergia a la penicilina sin confirmación y el uso de antimicrobianos alternativos tienen como efecto más fallas en el tratamiento; más efectos adversos graves; mayor costo; internaciones más prolongadas; incremento en la emergencia de gérmenes multirresistentes asociados a los cuidados de la salud. El riesgo de alergia cruzada entre grupos de ß-lactámicos suele ser <2%, dependiendo de la similitud de las cadenas laterales, por lo que prescribir antibióticos de otro grupo de ß-lactámicos es seguro siempre que tengamos en cuenta la similitud estructural. Incorporar la reevaluación de alergias y mejorar la prescripción de antibióticos en este grupo de pacientes, disminuye la generación y propagación de gérmenes multirresistentes, y los costos asociados. Existen métodos sencillos y escalas específicas que permiten simplificar la reevaluación de la alergia. El objetivo de esta revisión es exponer cómo a través de estos métodos, puede lograrse el desrotulado de pacientes erróneamente etiquetados como alérgicos y la prescripción segura de antibióticos ß-lactámicos.
Assuntos
Antibacterianos , Hipersensibilidade a Drogas , Penicilinas , beta-Lactamas , Humanos , Antibacterianos/efeitos adversos , Penicilinas/efeitos adversos , beta-Lactamas/efeitos adversos , Farmacorresistência Bacteriana Múltipla , Rotulagem de Medicamentos/normas , Reações Cruzadas , Antibióticos beta LactamRESUMO
BACKGROUND: Allergic sensitization to topical antimicrobial treatments is a well-known problem. Furacin® is one of the most widely used in our environment. It contains 0.2% nitrofurazone and polyethylene glycol (PEG) as a vehicle. CASE REPORT: 57-year-old male with no history of interest. He presented skin rash, blisters, and serous exudate 2-3 days after starting treatment with Furacin® (applied to an infected skin wound). Epicutaneous tests were performed with a true test battery, nitrofurantoin 1% in petrolatum, PEG15000 and 4000 1% in petrolatum, pure PEG 400, PEG monomethyl ether 350 1% in water. Positive result at 96 hours for nitrofurantoin. CONCLUSION: Nitrofurazone is widely used as a topical antibiotic because of its bactericidal spectrum. It (including its excipients) should be considered in case of adverse reactions after application.
ANTECEDENTES: La sensibilización o alergia a medicamentos antimicrobianos tópicos es un problema conocido. Furacin® representa uno de los fármacos más prescritos en nuestro medio; sus principios activos son: nitrofurazona al 0.2% y polietilenglicol (PEG) como vehículo. REPORTE DE CASO: Paciente masculino de 57 años, sin antecedentes de interés para el padecimiento actual, que inició con erupción cutánea, ampollas y exudado seroso 2 a 3 días después de aplicar Furacin® en una herida cutánea infectada. Se llevaron a cabo pruebas epicutáneas con batería true test, nitrofurantoína al 1% en vaselina, PEG 15000 y 4000 al 1% en vaselina, PEG 400 puro, y PEG monometil éter 350 al 1% en agua, con resultado positivo para nitrofurantoina luego de 96 horas. CONCLUSIÓN: La nitrofurazona se indica ampliamente como antibiótico tópico, debido a su espectro bactericida; no obstante, debe considerarse (incluidos sus excipientes) en pacientes que manifiestan reacciones adversas después de su aplicación.
Assuntos
Dermatite Alérgica de Contato , Humanos , Masculino , Pessoa de Meia-Idade , Dermatite Alérgica de Contato/etiologia , Nitrofurazona/efeitos adversos , Antibacterianos/efeitos adversosRESUMO
PURPOSE: The optimal duration of antibiotic therapy for fracture-related infection (FRI) has not been well defined. Our aim was to assess the recurrence rate of infection in patients who underwent six, 12, or 24 weeks of antibiotic therapy following surgical treatment for FRI one year after antibiotic discontinuation. Additionally, complications were monitored. METHODS: Patients with FRI underwent surgical treatment, and antibiotic therapy was initiated. The patients were divided into groups at the 6th and 12th weeks of antibiotic therapy. The primary endpoint was the recurrence of deep or superficial infection at 90 days and one year after the end of antimicrobial therapy. RESULTS: There was no difference in the recurrence of infection 90 days or one year after stopping antibiotic therapy among patients treated for six, 12, or 24 weeks (p = 0.98 and p = 0.19, respectively). The overall recurrence rate of infection 90 days after stopping antibiotic therapy was 4.9% (8/163), and one year after discontinuation of antibiotic therapy was 9.8% (16/163). There was a statistically significant difference in the incidence of adverse effects among the three groups (chi-square; p = 0.01). Adverse effects were more common in the group treated for 24 weeks than in the groups treated for 6 weeks (z score, p = 0.017) or 12 weeks (z score, p = 0.005). CONCLUSION: Antibiotic therapy longer than 6 weeks did not reduce the recurrence of FRI after one year of follow-up. Additionally, antibiotic treatment for 24 weeks increases adverse events such as skin reactions and acute renal failure.
Assuntos
Antibacterianos , Fraturas Ósseas , Recidiva , Infecção da Ferida Cirúrgica , Humanos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Fraturas Ósseas/cirurgia , Fraturas Ósseas/complicações , Infecção da Ferida Cirúrgica/tratamento farmacológico , Esquema de Medicação , Idoso , Fatores de Tempo , Estudos RetrospectivosRESUMO
Eosinophilia is a challenge to our everyday clinical practice. There are multiple causes to consider when diagnosing eosinophilia, and drug hypersensitivity must be taken into account. It is especially difficult to manage it in hospitalized patients with multiple complications and infections. Allergy tests are not always as helpful as we would like, so we rely on clinical observation and laboratory analysis to establish our diagnosis. We present a unique clinical case because the same patient presented two clinical episodes of eosinophilia after the administration of Carbapenems in the context of abdominal infection.
Assuntos
Antibacterianos , Carbapenêmicos , Eosinofilia , Humanos , Eosinofilia/induzido quimicamente , Eosinofilia/diagnóstico , Carbapenêmicos/efeitos adversos , Antibacterianos/efeitos adversos , Masculino , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , Pessoa de Meia-Idade , FemininoRESUMO
During the COVID-19 pandemic, several drugs were repositioned and combined to quickly find a way to mitigate the effects of the infection. However, the adverse effects of these combinations on the gastrointestinal tract are unknown. We aimed investigate whether Hydroxychloroquine (HD), Azithromycin (AZ), and Ivermectin (IV) used in combination for the treatment of COVID-19, can lead to the development of gastrointestinal disorders. This is a systematic review and network meta-analysis conducted using Stata and Revman software, respectively. The protocol was registered with PROSPERO (CRD42023372802). A search of clinical trials in Cochrane Library databases, Embase, Web of Science, Lilacs, PubMed, Scopus and Clinicaltrials.gov conducted on November 26, 2023. The eligibility of the studies was assessed based on PICO criteria, including trials that compared different treatments and control group. The analysis of the quality of the evidence was carried out according to the GRADE. Six trials involving 1,686 COVID-19 patients were included. No trials on the association of HD or AZ with IV met the inclusion criteria, only studies on the association between HD and AZ were included. Nausea, vomiting, diarrhea, abdominal pain and increased transaminases were related. The symptoms of vomiting and nausea were evaluated through a network meta-analysis, while the symptom of abdominal pain was evaluated through a meta-analysis. No significant associations with these symptoms were observed for HD, AZ, or their combination, compared to control. Low heterogeneity and absence of inconsistency in indirect and direct comparisons were noted. Limitations included small sample sizes, varied drug dosages, and potential publication bias during the pandemic peak. This review unveils that there are no associations between gastrointestinal adverse effects and the combined treatment of HD with AZ in the management of COVID-19, as compared to either the use of a control group or the administration of the drugs individually, on the other hand, highlighting the very low or low certainty of evidence for the evaluated outcomes. To accurately conclude the absence of side effects, further high-quality randomized studies are needed.
Assuntos
Azitromicina , Tratamento Farmacológico da COVID-19 , Quimioterapia Combinada , Gastroenteropatias , Hidroxicloroquina , Metanálise em Rede , SARS-CoV-2 , Azitromicina/uso terapêutico , Azitromicina/efeitos adversos , Humanos , Hidroxicloroquina/uso terapêutico , Hidroxicloroquina/efeitos adversos , Gastroenteropatias/induzido quimicamente , Gastroenteropatias/epidemiologia , COVID-19 , Ivermectina/uso terapêutico , Ivermectina/efeitos adversos , Antibacterianos/uso terapêutico , Antibacterianos/efeitos adversos , Antivirais/uso terapêutico , Antivirais/efeitos adversosAssuntos
Antibacterianos , Cefdinir , Fezes , Humanos , Antibacterianos/efeitos adversos , Fezes/química , Cefalosporinas/efeitos adversos , Masculino , Feminino , CriançaRESUMO
Antibiotic prophylaxis in patients with cirrhosis and acute variceal bleeding is part of the standard of care according to most clinical guidelines. However, with recent evidence arguing against antibiotic prophylaxis, the role of this intervention has become less clear.
Assuntos
Antibacterianos , Antibioticoprofilaxia , Varizes Esofágicas e Gástricas , Hemorragia Gastrointestinal , Cirrose Hepática , Humanos , Antibioticoprofilaxia/métodos , Antibioticoprofilaxia/normas , Hemorragia Gastrointestinal/prevenção & controle , Hemorragia Gastrointestinal/etiologia , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/diagnóstico , Cirrose Hepática/complicações , Antibacterianos/uso terapêutico , Antibacterianos/efeitos adversos , Guias de Prática Clínica como Assunto , Doença Aguda , Resultado do TratamentoRESUMO
ABSTRACT: We conducted a systematic literature review and meta-analysis to assess the efficacy of alternative treatments for neurosyphilis. We searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane, Scopus, and Web of Science from database inception to September 2023, for studies in neurosyphilis that compared penicillin monotherapy with other treatments. We focused on the impact of these therapies on treatment response, but also assessed data regarding reinfection and adverse drug events. Random-effect models were used to obtain pooled mean differences. Of 3415 screened studies, 6 met the inclusion criteria for the systematic literature review. Three studies provided quantitative data that allowed for inclusion in the meta-analysis. Our analysis revealed that the efficacy of intravenous (IV) ceftriaxone 2 g daily for 10 days (51 patients) did not appear statistically different compared with IV penicillin G 18 to 24 million units daily for 10 days (185 patients) for neurosyphilis (pooled odds ratio, 2.85; 95% confidence interval, 0.41-19.56; I 2 = 49%). No statistical difference between ceftriaxone and penicillin was identified in people living with human immunodeficiency virus (HIV) (pooled odds ratio, 4.51; 95% confidence interval, 0.50-40.49; I 2 = 34%). We concluded that alternative therapy with IV ceftriaxone appears similar to penicillin, potentially expanding treatment options for neurosyphilis. Other treatment options including doxycycline warrant further study.
Assuntos
Antibacterianos , Neurossífilis , Humanos , Masculino , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Ceftriaxona/administração & dosagem , Ceftriaxona/efeitos adversos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/complicações , Neurossífilis/complicações , Neurossífilis/tratamento farmacológico , Penicilina G/administração & dosagem , Penicilina G/efeitos adversos , Penicilinas/administração & dosagem , Penicilinas/efeitos adversos , Resultado do TratamentoRESUMO
Bilateral acute depigmentation of the iris and bilateral acute iris transillumination (BAIT) are similar clinical entities. The former causes acute-onset depigmentation of the iris stroma without transillumination, whereas the latter causes depigmentation of the iris pigment epithelium with transillumination. The etiopathogenesis of these conditions is not yet fully understood, but the proposed causes include the use of systemic antibiotics (especially moxifloxacin) and viral triggers. We present a case series of five female patients with a mean age of 41 (32-45) years, all of whom suffered acute onset of bilateral pain and redness of the eyes after moxifloxacin use (oral or topical). It is important for ophthalmologists to be aware of the two forms of iris depigmentation since this case series suggests that SARS-CoV-2 or its empirical treatment with moxifloxacin may trigger iris depigmentation. If this is the case, clinicians will likely see increased incidences of bilateral acute depigmentation of the iris and bilateral acute iris transillumination during and after the COVID-19 pandemic.
Assuntos
COVID-19 , Doenças da Íris , Humanos , Feminino , Adulto , Doenças da Íris/induzido quimicamente , Pessoa de Meia-Idade , COVID-19/complicações , Brasil , Doença Aguda , Moxifloxacina/efeitos adversos , Moxifloxacina/uso terapêutico , Transiluminação , SARS-CoV-2 , Transtornos da Pigmentação/induzido quimicamente , Iris/patologia , Antibacterianos/efeitos adversos , Epitélio Pigmentado Ocular/patologia , Epitélio Pigmentado Ocular/efeitos dos fármacosRESUMO
OBJECTIVES: To validate the efficacy and safety of withholding antimicrobial therapy in a new cohort of children with cancer and febrile neutropenia (FN) having a demonstrated viral respiratory tract infection. METHODS: Prospective, multicenter, noninferiority, randomized study, approved by the ethical committee, in children presenting with FN at seven hospitals in Chile, evaluated at admission for diagnosis of bacterial and viral pathogens. Children who were positive for a respiratory virus, negative for a bacterial pathogen, and had a favourable evolution after 48-72 hours of antimicrobial therapy were randomized to either maintain or withhold antimicrobial therapy. The primary endpoint was the percentage of episodes with an uneventful resolution, whereas the secondary endpoints were days of fever, days of hospitalization, requirement of antimicrobial treatment readministration, sepsis, paediatric intensive care unit admission, and death. RESULTS: A total of 301 of 939 children with FN episodes recruited between March 2021 and December 2023 had a respiratory virus as a unique identified microorganism, of which 139 had a favourable evolution at 48-72 hours and were randomized, 70 to maintain and 69 to withdraw antimicrobial therapy. The median days of antimicrobial therapy was 5 (IQR 3-6) versus 3 (IQR 3-6) days (p < 0.001), with similar frequency of uneventful resolution 66/70 (94%) and 66/69 (96%); relative risk, 1.01; (95% CI, 0.93 to 1.09), absolute risk difference 0.01; (95% CI, -0.05 to 0.08) and similar number of days of fever and days of hospitalization. No cases of sepsis, paediatric intensive care unit admission, or death were reported. DISCUSSION: We validated the strategy of withdrawal antimicrobial therapy in children with FN and viral respiratory tract infection based on clinical and microbiological/molecular diagnostic criteria. This will enable advances in antimicrobial stewardship strategies with a possible future impact on antimicrobial resistance.
Assuntos
Neoplasias , Infecções Respiratórias , Viroses , Humanos , Masculino , Feminino , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/virologia , Criança , Pré-Escolar , Estudos Prospectivos , Viroses/tratamento farmacológico , Neoplasias/tratamento farmacológico , Neoplasias/complicações , Chile , Neutropenia Febril/tratamento farmacológico , Lactente , Suspensão de Tratamento , Febre/tratamento farmacológico , Resultado do Tratamento , Anti-Infecciosos/uso terapêutico , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/efeitos adversos , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Hospitalização , AdolescenteRESUMO
Urinary tract infections (UTI) affect between 3% to 7.5% of the febrile pediatric population each year, being one of the most common bacterial infections in pediatrics. Nevertheless, there is no consensus in the medical literature regarding the duration of per oral (p.o.) antibiotic therapy for UTI among these patients. Therefore, our meta-analysis aims to assess the most effective therapy length in this scenario. PubMed, Cochrane, and Embase were searched for randomized controlled trials (RCTs) comparing short (≤ 5 days) with long-course (≥ 7 days) per os (p.o.) antibiotic therapy for children with UTI. Statistical analysis was performed using R Studio version 4.2.1, heterogeneity was assessed with I2 statistics, and the risk of bias was evaluated using the RoB-2 tool. Risk Ratios (RR) with p < 0.05 were considered statistically significant. Seventeen studies involving 1666 pediatric patients were included. Of these, 890 patients (53.4%) were randomized to receive short-course therapy. Patients undergoing short-course therapy showed higher treatment failure rates (RR 1.61; 95% CI 1.15-2.27; p = 0.006). Furthermore, there were no statistically significant differences between groups regarding reinfection (RR 0.73; 95% CI 0.47-1.13; p = 0156) and relapse rates (RR 1.47; 95% CI 0.8-2.71; p = 0.270). Conclusion: In summary, our results suggest that long-course p.o. antibiotic therapy is associated with a lower rate of treatment failure when compared to short-course p.o. antibiotic therapy. There was no statistical difference between both courses regarding reinfection and relapse rates within 15 months. PROSPERO identifier: CRD42023456745. What is Known: ⢠Urinary tract infections (UTIs) are common in children, affecting around 7.5% of those under 18. ⢠The optimal duration of antibiotic treatment for pediatric UTIs has been a subject of debate. What is New: ⢠Short-course therapy (5 or fewer days) was associated with a significantly higher failure rate when compared to long-course therapy. ⢠There was no significant difference in reinfection and relapse rates within 15 months between short and long-course therapy.
Assuntos
Antibacterianos , Esquema de Medicação , Infecções Urinárias , Criança , Humanos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Infecções Urinárias/tratamento farmacológicoRESUMO
BACKGROUND: Human brucellosis is a neglected, re-emerging, and endemic zoonosis in many countries. The debilitating and disabling potential of the disease is a warning about its morbidity, generating socioeconomic impact. This review aims to update the current evidence on the efficacy and safety of therapeutic options for human brucellosis using the network meta-analysis (NMA). METHODOLOGY: A systematic search was conducted in four different databases by independent reviewers to assess overall therapy failure, adverse events, and time to defervescence associated with different therapies. Randomized clinical trials (RCTs) evaluating any therapeutic drug intervention were selected, excluding non-original studies or studies related to localized forms of the disease or with less than 10 participants. Data were analyzed by frequentist statistics through NMA by random effects model. The risk of bias and certainty of evidence was assessed, this review was registered at PROSPERO. RESULTS: Thirty-one (31) RCTs involving 4167 patients were included. Three networks of evidence were identified to evaluate the outcomes of interest. Triple therapy with doxycycline + streptomycin + hydroxychloroquine for 42 days (RR: 0.08; CI 95% 0.01-0.76) had a lower failure risk than the doxycycline + streptomycin regimen. Doxycycline + rifampicin had a higher risk of failure than doxycycline + streptomycin (RR: 1.96; CI 95% 1.27-3.01). No significant difference was observed between the regimens when analyzing the incidence of adverse events and time to defervescence. In general, most studies had a high risk of bias, and the results had a very low certainty of evidence. CONCLUSIONS: This review confirmed the superiority of drugs already indicated for treating human brucellosis, such as the combination of doxycycline and aminoglycosides. The association of hydroxychloroquine to the dual regimen was identified as a potential strategy to prevent overall therapy failure, which is subject to confirmation in future studies.
Assuntos
Antibacterianos , Brucelose , Doxiciclina , Quimioterapia Combinada , Metanálise em Rede , Estreptomicina , Humanos , Brucelose/tratamento farmacológico , Antibacterianos/uso terapêutico , Antibacterianos/efeitos adversos , Doxiciclina/uso terapêutico , Doxiciclina/efeitos adversos , Estreptomicina/uso terapêutico , Hidroxicloroquina/uso terapêutico , Hidroxicloroquina/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Rifampina/uso terapêutico , Rifampina/efeitos adversos , Resultado do TratamentoRESUMO
OBJECTIVES: This study aimed to evaluate the clinical and microbiological risk factors associated with mortality in patients treated with ceftazidime-avibactam for carbapenem-resistant Gram-negative bacterial infections. METHODS: This multicentric prospective cohort study included hospitalized adult patients with a microbiologically confirmed infection treated with ceftazidime-avibactam for ≥48 hours. The clinical and microbiological risk factors for 30-day mortality were evaluated using a Cox regression model. RESULTS: Of the 193 patients evaluated from the five tertiary hospitals, 127 were included in the study. Thirty-five patients (27.6%) died within 30 days. Infections with AmpC beta-lactamase-carrying bacteria were independently related to 30-day mortality (adjusted hazard ratio [aHR] 2.49, 95% confidence interval [CI] 1.28-4.84, P < 0.01) after adjusting for time from infection to antimicrobial prescription (P = 0.04). Further, these bacterial infections were also related to higher in-hospital mortality (aHR 2.17, 95% CI 1.24-3.78, P < 0.01). Only one patient developed resistance to ceftazidime-avibactam during treatment. CONCLUSIONS: Treatment with ceftazidime-avibactam had worse clinical outcomes in patients with infections with bacteria with chromosomally encoded AmpC beta-lactamase. However, these findings should be confirmed in future studies.
Assuntos
Antibacterianos , Compostos Azabicíclicos , Infecções por Bactérias Gram-Negativas , Adulto , Humanos , Antibacterianos/efeitos adversos , Antibacterianos/farmacologia , Inibidores de beta-Lactamases/efeitos adversos , Ceftazidima/efeitos adversos , Combinação de Medicamentos , Farmacorresistência Bacteriana Múltipla , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Estudos ProspectivosRESUMO
Dysbiosis corresponds to the disruption of a formerly stable, functionally complete microbiota. In the gut, this imbalance can lead to adverse health outcomes in both the short and long terms, with a potential increase in the lifetime risks of various noncommunicable diseases and disorders such as atopy (like asthma), inflammatory bowel disease, neurological disorders, and even behavioural and psychological disorders. Although antibiotics are highly effective in reducing morbidity and mortality in infectious diseases, antibiotic-associated diarrhoea is a common, non-negligible clinical sign of gut dysbiosis (and the only visible one). Re-establishment of a normal (functional) gut microbiota is promoted by completion of the clinically indicated course of antibiotics, the removal of any other perturbing external factors, the passage of time (i.e. recovery through the microbiota's natural resilience), appropriate nutritional support, and-in selected cases-the addition of probiotics. Systematic reviews and meta-analyses of clinical trials have confirmed the strain-specific efficacy of some probiotics (notably the yeast Saccharomyces boulardii CNCM I-745 and the bacterium Lactobacillus rhamnosus GG) in the treatment and/or prevention of antibiotic-associated diarrhoea in children and in adults. Unusually for a probiotic, S. boulardii is a eukaryote and is not therefore directly affected by antibiotics-making it suitable for administration in cases of antibiotic-associated diarrhoea. A robust body of evidence from clinical trials and meta-analyses shows that the timely administration of an adequately dosed probiotic (upon initiation of antibiotic treatment or within 48 h) can help to prevent or resolve the consequences of antibiotic-associated dysbiosis (such as diarrhoea) and promote the resilience of the gut microbiota and a return to the pre-antibiotic state. A focus on the prescription of evidence-based, adequately dosed probiotics should help to limit unjustified and potentially ineffective self-medication.
Assuntos
Lacticaseibacillus rhamnosus , Probióticos , Saccharomyces boulardii , Adulto , Criança , Humanos , Antibacterianos/efeitos adversos , Diarreia/induzido quimicamente , Diarreia/prevenção & controle , Disbiose/induzido quimicamente , Disbiose/terapia , Probióticos/uso terapêutico , Saccharomyces cerevisiae , Metanálise como Assunto , Revisões Sistemáticas como AssuntoRESUMO
BACKGROUND: Antimicrobials are widely used in hospitals and are often associated with adverse drug reactions (ADRs). The objective of this study was to determine the incidence of ADRs caused by antimicrobials and classify them according to the type of reaction, the class of antimicrobials used, causality, severity and avoidability. METHODS: A prospective cohort study was carried out with paediatric patients for 6 months. Causality was verified using the Naranjo and Liverpool algorithms, the severity was verified with the adapted scale of Hartwig and the avoidability was verified with the Liverpool Avoidability Assessment Tool. RESULTS: A total of 303 patients were followed, and 18.2% (55/303) of them had one or more ADRs during the hospital stay. Just over half of the patients (28/55) had diarrhea. The most used antimicrobials were beta-lactams and second-generation cephalosporins. Suspicions were classified mainly as possible 78.6% (55/70) according to the Naranjo algorithm, and as probable 48.6% (34/70) according to the Liverpool algorithm. The antimicrobial most involved with ADRs was cefepime. The risk of manifesting ADR was greater with the use of some antimicrobials such as clindamycin (relative risk (RR) 3.0, CI 1.67 to 5.4), as well as with the increase in hospitalisation days (OR 1.022, CI 1.008 to 1.036) and in the number of antimicrobials prescribed (OR 1.649, CI 1.360 to 2.001). CONCLUSION: ADRs were observed in approximately one-fifth of patients and were mostly gastrointestinal, moderate, unavoidable and with variable causality, depending on the algorithm used.
Assuntos
Centros de Atenção Terciária , Humanos , Masculino , Centros de Atenção Terciária/tendências , Feminino , Estudos Prospectivos , Pré-Escolar , Criança , Lactente , Estudos de Coortes , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Anti-Infecciosos/efeitos adversos , Adolescente , Hospitalização/estatística & dados numéricos , Antibacterianos/efeitos adversos , IncidênciaRESUMO
OBJECTIVE: To develop a treatment algorithm for patients with penicillin allergy. METHODS: Retrospective study, carried out in adult patients with penicillin allergy, who were in group 3 or 4 of the established classification, and attended the outpatient clinic of the Department of Pulmonology and Allergy of the Central Hospital of the Social Security Institute, between January 2021 and December 2022. Each patient underwent an amoxicillin provocation test, after obtaining informed consent. RESULTS: 60 patients were registered, who were able to remove the penicillin allergy label and whose medical history was corrected, with financial benefits for the patient and the health service of Paraguay. CONCLUSIONS: Penicillin allergy labels can lead to irrational prescription of antibiotics, prolonged hospital stays, and increased need for consultation. Risk stratification, based on historical characteristics alone, is capable of safely identifying ideal patients for direct challenge testing. This study demonstrates the feasibility of the first penicillin delabeling program applicable in an outpatient setting, which can be performed even outside of hospital allergy services.
OBJETIVO: Elaborar un algoritmo de tratamiento en pacientes con alergia a la penicilina. MÉTODOS: Estudio retrospectivo, efectuado en pacientes adultos con alergia a la penicilina, que permanecieran en el grupo 3 o 4 de la clasificación establecida, y asistieron a consulta ambulatoria en el Departamento de Neumología y Alergia del Hospital Central del Instituto de Previsión Social, entre enero de 2021 y diciembre de 2022. A cada paciente se realizó una prueba de provocación con amoxicilina, previo consentimiento informado. RESULTADOS: Se registraron 60 pacientes, a quienes se logró eliminar el rotulo de alergia a la penicilina y a quienes se corrigió su historia clínica, con beneficios financieros para el paciente y el servicio de salud de Paraguay. CONCLUSIÓN: Las etiquetas de alergia a la penicilina pueden suponer una prescripción irracional de antibióticos, estancia hospitalaria prolongada y mayor necesidad de consulta. La estratificación del riesgo, solo por características históricas, es capaz de identificar de manera segura a los pacientes ideales para las pruebas de desafío directo. Este estudio demuestra la viabilidad del primer programa de desetiquetado de penicilina aplicable en un entorno ambulatorio, que puede realizarse incluso fuera de los servicios de alergia de los hospitales.
Assuntos
Hipersensibilidade a Drogas , Penicilinas , Centros de Atenção Terciária , Humanos , Hipersensibilidade a Drogas/etiologia , Paraguai , Estudos Retrospectivos , Penicilinas/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Algoritmos , Idoso , Adulto Jovem , Antibacterianos/efeitos adversosRESUMO
INTRODUCCIÓN: El uso de tigeciclina ha ido en aumento en los últimos años, debido al incremento de la resistencia bacteriana y la escasez de alternativas terapéuticas. OBJETIVO: Caracterizar y evaluar las prescripciones de tigeciclina en pacientes internados en un hospital universitario, durante los años 2017 y 2018. METODOLOGÍA: Estudio observacional retrospectivo, donde se caracterizaron los pacientes, las terapias, la microbiología asociada, los desenlaces clínicos y las reacciones adversas asociadas a los tratamientos con tigeciclina. Se determinó la proporción de prescripciones apropiadas por un comité de expertos y el consumo de tigeciclina medido en DDD/100 camas-día. RESULTADOS: Se caracterizaron 89 pacientes, de los cuales 67 (75,3%) cumplieron los criterios de selección. El 53,7% de los pacientes eran hombres, con una edad promedio de 60 ± 15 años. El principal motivo de hospitalización fue quirúrgico (65,7%). El 67,1% de los tratamientos con tigeciclina se inició en una Unidad de Paciente Critico y el foco de infección predominante fue abdominal (64,3%). El 50% de las terapias con tigeciclina fueron dirigidas según la microbiología identificada. En 65,7% de los casos se usó tigeciclina como monoterapia en la dosis habitual (62,9%). Náuseas (8,6%), diarrea (7,1%) y vómitos (4,3%) fueron los efectos adversos más reportados. El 84,3% de los tratamientos se consideraron apropiados. El año 2017 se consumió 0,4 DDD/100 camas-día y 0,6 DDD/100 camas/día el 2018, siendo la UCI el servicio que presentó el mayor uso en ambos años. DISCUSIÓN: Tigeciclina fue utilizada principalmente en monoterapia para el tratamiento de infecciones intraabdominales en pacientes hospitalizados, por motivos quirúrgicos, en una unidad de paciente crítico, en las dosis habituales recomendadas de 100 mg como dosis de carga seguida de 50 mg cada 12 hs IV. En 50% de los casos, la terapia fue dirigida según microbiología. Los eventos adversos más habituales fueron los gastrointestinales. CONCLUSIÓN: La mayoría de las terapias prescritas fueron consideradas apropiadas por el comité de expertos.
BACKGROUND: The use of tigecycline has been increasing in recent years, due to increase in bacterial resistance and the scarcity of therapeutics alternatives. AIM: To characterize and evaluate the tigecycline prescriptions of patients hospitalized in a university hospital, during the years 2017 and 2018. METHODS: A retrospective observational study was carried out, where the patients, the therapies, the associated microbiology, the clinical outcomes and the adverse reactions associated with tigecycline were characterized. The proportion of appropriate prescriptions was determined by committee of experts and the consumption of tigecycline measure in DDD/100 bed-days. RESULTS: 89 patients who used tigecycline were characterized, of which 67 (75.3%) met the selection criteria. 53.7% of the patients were male, with a mean age of 60 +/- 15 years The main reason for hospitalization was surgical (65.7%). 67.1% of the treatments with tigecycline were started in a critical patient unit and the predominant focus of the infection was the abdomen (64.3%). 50% of the therapies with tigecycline were ordered according to the identified microbiology. In 65.7% of the cases, tigecyclin was used as monotherapy at the usual dose (62.9%). Nausea (8.6%), diarrhea (7.1%) and vomiting (4.3%) were the most reported adverse events. 84.3% of the treatments were considered appropriate. In 2017, 0.4 DDD/100 bed/days were consumed and 0.6 DDD/100 bed/days in 2018, with de ICU being the service that presented the highest use in both years. DISCUSSION: Tigecycline was mainly used as monotherapy for the treatment of intra-abdominal infections in patients hospitalized for surgical reasons in a critical patient unit at the usual doses of 100 mg loading followed by 50 mg every 12 hours IV. In 50% of the case the therapy was directed according to microbiology. The most common adverse events were gastrointestinal. CONCLUSION: Most of the prescribed therapies were considered appropriate by the expert committee.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Tigeciclina/uso terapêutico , Antibacterianos/uso terapêutico , Prescrições de Medicamentos , Chile , Estudos Retrospectivos , Farmacorresistência Bacteriana , Infecções Intra-Abdominais/tratamento farmacológico , Tigeciclina/administração & dosagem , Tigeciclina/efeitos adversos , Hospitais Universitários , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversosRESUMO
Objectives: To confirm the presence of allergy to penicillin and amoxicillin by in vivo exposure tests in patients with a history of immediate reaction to these drugs. Methods: Observational, cross-sectional, descriptive and prolective study. Patients between 12 and 60 years old with a history of immediate reaction after administration of penicillin and/or amoxicillin were included. Skin prick and intradermal tests were performed with benzylpenicilloyl polylysine and penicillin G, as well as oral challenge with amoxicillin. Results: Ten female and 3 male patients were included. The mean age was 39 years. In 84.6% of the cases the last adverse drug reaction occurred 10 years ago and in all cases it manifested with urticaria. Allergy to penicillin was corroborated in only 38.4% of cases. The most frequent adverse reaction after in vivo exposure tests was pruritus in 23%. Conclusions: Patients with suspected penicillin allergy should be evaluated by in vivo exposure testing with major and minor determinants to corroborate or rule out allergic reactions and improve treatment conditions.
Objetivos: Confirmar la presencia de alergia a penicilina y amoxicilina mediante pruebas de exposición in vivo, en pacientes que refieren antecedente de reacción inmediata con estos medicamentos. Métodos: Estudio observacional, transversal, descriptivo y prolectivo. Se incluyeron pacientes entre 12 y 60 años con antecedente de reacción inmediata tras administración de penicilina y/o amoxicilina. Se realizaron pruebas cutáneas por prick e intradérmicas con bencilpeniciloil polilisina y penicilina G, así como desafío oral con amoxicilina. Resultados: Se incluyeron 10 pacientes femeninos y 3 masculinos. La edad promedio fue 39 años. En 84,6% de los casos la última reacción adversa a medica- mentos ocurrió 10 años atrás y en todos los casos se manifestó con urticaria. Sólo en el 38,4% se corroboró alergia a penicilina. La reacción adversa más frecuen- te, tras las pruebas de exposición in vivo fue prurito en el 23%. Conclusiones: Los pacientes con sospecha de alergia a penicilina se deben evaluar mediante pruebas de exposición in vivo con los determinantes mayores y menores, para corroborar o descartar reacciones alérgicas y mejorar las condiciones de tratamiento.