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1.
Zhonghua Er Ke Za Zhi ; 58(1): 41-45, 2020 Jan 02.
Artigo em Chinês | MEDLINE | ID: mdl-31905475

RESUMO

Objective: To evaluate the effectiveness of eradication therapy based on Helicobacter pylori (Hp) susceptibility and CYP2C19 genotype in children with refractory Hp infection. Methods: In this prospective observational cohort study, 156 children with Hp refractory to amoxicillin+clarithromycin+omeprazole triple regimen in Baoding Children's Hospital from December 2017 to May 2018 were enrolled. Ninety-two of them underwent Hp culture and CYP2C19 detection. Seventy-five cases with positive Hp culture were defined as culture successful group and were treated according to Hp susceptibility and CYP2C19 genotype. Seventeen cases with negative Hp culture were defined as culture failed group and were treated only based on the results of CYP2C19 genotype. Sixty-four children who did not have Hp culture and CYP2C19 gene testing were defined as the empirical eradication therapy group and were treated with quadruple regimen (amoxicillin+metronidazole+omeprazole+bismuth). Bacterial resistance, CYP2C19 polymorphism and therapeutic effectiveness between the three groups were compared using chi-square test. Results: Among the 75 positive Hp culture results, 72 (96%) were resistant to clarithromycin, 3 (4%) were resistant to metronidazole, 5 (7%) were resistant to levofloxacin, 5 (7%) were resistant to rifampicin, 1 (1%) was resistant to tetracycline, and none was resistant to amoxicillin and furazolidone. The CYP2C19 polymorphism in 92 patients showed that 43 (47%) were extensive metabolizer (EM), 9 (10%) were poor metabolizer (PM), and 40 (43%) were intermediate metabolizer (IM). In terms of the effectiveness, eradication rate in the culture successful group,culture failed group and empirical eradication therapy group were 99% (74/75), 88% (15/17) and 72% (46/64), respectively (χ(2)=21.325, P<0.05). The eradication rate in the culture successful group was significantly higher than that in empirical eradication therapy group (χ(2)=21.005, P<0.05), while there was no difference between empirical eradication therapy group and culture failed group (χ(2)=1.154, P=0.283). Conclusion: Eradication regimen based on bacterial susceptibility and CYP2C19 genotype should be considered in children with refractory Hp infection.


Assuntos
Citocromo P-450 CYP2C19/genética , Quimioterapia Combinada , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/genética , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/genética , Omeprazol/uso terapêutico , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Bismuto/uso terapêutico , Criança , Claritromicina/administração & dosagem , Claritromicina/uso terapêutico , Estudos de Coortes , Resistência a Medicamentos/genética , Feminino , Genótipo , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Metronidazol/uso terapêutico , Omeprazol/administração & dosagem , Polimorfismo Genético , Estudos Prospectivos , Resultado do Tratamento
2.
N Engl J Med ; 382(5): 427-436, 2020 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-31995688

RESUMO

BACKGROUND: Helicobacter pylori infection and a family history of gastric cancer are the main risk factors for gastric cancer. Whether treatment to eradicate H. pylori can reduce the risk of gastric cancer in persons with a family history of gastric cancer in first-degree relatives is unknown. METHODS: In this single-center, double-blind, placebo-controlled trial, we screened 3100 first-degree relatives of patients with gastric cancer. We randomly assigned 1838 participants with H. pylori infection to receive either eradication therapy (lansoprazole [30 mg], amoxicillin [1000 mg], and clarithromycin [500 mg], each taken twice daily for 7 days) or placebo. The primary outcome was development of gastric cancer. A prespecified secondary outcome was development of gastric cancer according to H. pylori eradication status, assessed during the follow-up period. RESULTS: A total of 1676 participants were included in the modified intention-to-treat population for the analysis of the primary outcome (832 in the treatment group and 844 in the placebo group). During a median follow-up of 9.2 years, gastric cancer developed in 10 participants (1.2%) in the treatment group and in 23 (2.7%) in the placebo group (hazard ratio, 0.45; 95% confidence interval [CI], 0.21 to 0.94; P = 0.03 by log-rank test). Among the 10 participants in the treatment group in whom gastric cancer developed, 5 (50.0%) had persistent H. pylori infection. Gastric cancer developed in 0.8% of participants (5 of 608) in whom H. pylori infection was eradicated and in 2.9% of participants (28 of 979) who had persistent infection (hazard ratio, 0.27; 95% CI, 0.10 to 0.70). Adverse events were mild and were more common in the treatment group than in the placebo group (53.0% vs. 19.1%; P<0.001). CONCLUSIONS: Among persons with H. pylori infection who had a family history of gastric cancer in first-degree relatives, H. pylori eradication treatment reduced the risk of gastric cancer. (Funded by the National Cancer Center, South Korea; ClinicalTrials.gov number, NCT01678027.).


Assuntos
Antibacterianos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Inibidores da Bomba de Prótons/uso terapêutico , Neoplasias Gástricas/prevenção & controle , Adenoma/epidemiologia , Adenoma/etiologia , Adenoma/prevenção & controle , Adulto , Idoso , Amoxicilina/uso terapêutico , Claritromicina/uso terapêutico , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Infecções por Helicobacter/complicações , Humanos , Incidência , Estimativa de Kaplan-Meier , Lansoprazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , República da Coreia , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/etiologia , Neoplasias Gástricas/genética
3.
Rev Med Suisse ; 15(667): 1854-1858, 2019 Oct 16.
Artigo em Francês | MEDLINE | ID: mdl-31617972

RESUMO

Helicobacter pylori infection is associated with chronic gastric inflammation, peptic ulcer and an increased risk of gastric cancer. Helicobacter eradication traditionally consists of an empirical therapy combining clarithromycine, amoxicillin and proton pump inhibitors. However, this classic therapy needs to be reassessed because of the raising prevalence of clarithromycine resistance. Various alternative eradication treatments have been studied. This article aims to review the recommended alternatives and the different factors to guide the most appropriate first line eradication therapy.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/microbiologia , Helicobacter pylori/efeitos dos fármacos , Amoxicilina/farmacologia , Amoxicilina/uso terapêutico , Antibacterianos/farmacologia , Claritromicina/farmacologia , Claritromicina/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Quimioterapia Combinada , Humanos , Inibidores da Bomba de Prótons/farmacologia , Inibidores da Bomba de Prótons/uso terapêutico
4.
Orv Hetil ; 160(34): 1340-1345, 2019 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-31423829

RESUMO

Introduction and aim: As the efficacy of the first-line traditional treatment used to eradicate Helicobacter pylori (H. p.) decreased below 75% in Hungary, a new protocol had to be created. Method: Supposing the success rate of the traditional therapy (14-day double dose of proton pump inhibitor [PPI], 1000 mg amoxicillin b.i.d., 500 mg clarithromycin b.i.d. [PAC]) to be 75% and the efficacy of the new protocol (10-day 120 mg bismuth dicitrate q.i.d., double dose PPI b.i.d., 500 mg tetracycline q.i.d. and 500 mg tinidazole b.i.d. [BQT]) to be 90%, we calculated 109 patients on each arm. Patients were recruited after upper gastrointestinal endoscopy from 5 endoscopic units in Vas county. The heterogeneity of groups, success rate and side effects of both therapies were evaluated by Fisher exact test; p<0.05 was considered significant. Results: 110 patients were included in the BQT and 109 patients in the PAC group. There was no heterogeneity between the two groups in age, gender and indication of eradication. H. p. eradication was successful in 103/110 (93.6%) in the BQT and 81/109 (74.3%) in the PAC group (p<0.001). The odds ratio in the BQT group for successful eradication was 5.05 (95% confidence interval: 2.02-14.42) as compared to the PAC group (p<0.001). The side effects of the two groups were similar, in the BQT group the frequency was 34.5%. Conclusion: 10 day-long BQT containing double dose PPI with 120 mg bismuth dicitrate q.i.d., 500 mg tetracycline q.i.d. and 500 mg tinidazole b.i.d. is recommended as the first-line treatment for the eradication of H. p. because of its high efficacy and tolerable side effects. Orv Hetil. 2019; 160(34): 1340-1345.


Assuntos
Antiácidos/administração & dosagem , Antibacterianos/administração & dosagem , Bismuto/administração & dosagem , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Inibidores da Bomba de Prótons/administração & dosagem , Adulto , Idoso , Amoxicilina/administração & dosagem , Amoxicilina/uso terapêutico , Antiácidos/uso terapêutico , Antibacterianos/uso terapêutico , Bismuto/uso terapêutico , Claritromicina/administração & dosagem , Claritromicina/uso terapêutico , Esquema de Medicação , Farmacorresistência Bacteriana , Quimioterapia Combinada , Endoscopia Gastrointestinal , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/isolamento & purificação , Humanos , Hungria , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico , Tetraciclina/administração & dosagem , Tetraciclina/uso terapêutico , Tinidazol/administração & dosagem , Tinidazol/uso terapêutico , Resultado do Tratamento
5.
Indian J Med Microbiol ; 37(1): 127-131, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31424025

RESUMO

We report here the first case of pulmonary infection due to Mycobacterium kyorinense in a 55-year-old hypertensive woman treated for pulmonary tuberculosis earlier on two occasions. She presented with productive cough, intermittent episode of left-sided chest pain, loss of appetite, low-grade fever, and breathlessness. Sputum cultures revealed non-tuberculous mycobacteria (NTM). She remained persistently symptomatic with sputum cultures positive for acid-fast bacilli even after 6 months of treatment. Hence, a 16SrRNA gene amplification and sequencing were done that revealed M. kyorinense. Based on the guidelines of the American Thoracic Society, she was started on weight-based dosing of clarithromycin, levofloxacin, ethambutol, isoniazid and injection amikacin daily. The patient improved symptomatically and became culture-negative after 3 months of therapy with the above regimen and continued to be culture negative for 12 months of treatment. She continues to remain symptom-free without evidence of any clinical or bacteriological relapse.


Assuntos
Antituberculosos/uso terapêutico , Infecções por Micobactéria não Tuberculosa/diagnóstico , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Mycobacterium/genética , Infecções Respiratórias/diagnóstico , Amicacina/uso terapêutico , Claritromicina/uso terapêutico , Etambutol/uso terapêutico , Feminino , Humanos , Isoniazida/uso terapêutico , Levofloxacino/uso terapêutico , Pessoa de Meia-Idade , Mycobacterium/isolamento & purificação , Infecções por Micobactéria não Tuberculosa/microbiologia , RNA Ribossômico 16S/genética , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/microbiologia
6.
Sleep Med Clin ; 14(3): 333-350, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31375202

RESUMO

Idiopathic hypersomnia (IH) is characterized by excessive daytime sleepiness despite normal or prolonged sleep. IH is distinguished from narcolepsy by the female predominance, severe morning inertia, continuous drowsiness (rather than sleep attacks), unrefreshing naps, absence of cataplexy, sleep onset in REM periods, and hypocretin deficiency. In IH, the multiple sleep latency test demonstrates low sensitivity, specificity, and reproducibility, compared with prolonged sleep monitoring. In some IH cases, an endogenous hypnotic peptide stimulating GABA receptors during wakefulness is suspected, which are improved by anti-GABA drugs. The benefits of modafinil, sodium oxybate, mazindol, and pitolisant were found in mostly retrospective studies.


Assuntos
Moduladores GABAérgicos/uso terapêutico , Promotores da Vigília/uso terapêutico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Claritromicina/uso terapêutico , Flumazenil/uso terapêutico , Humanos , /fisiopatologia , Mazindol/uso terapêutico , Modafinila/uso terapêutico , Orexinas/metabolismo , Piperidinas/uso terapêutico , Polissonografia , Medicina de Precisão , Sono , Oxibato de Sódio/uso terapêutico , Vigília
7.
Rev Soc Bras Med Trop ; 52: e20190039, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31340363

RESUMO

INTRODUCTION: The growing incidence of post-surgical atypical mycobacteriosis (PSAM) may be related to the increased use of low- and medium-complexity video-assisted surgery. METHODS: Between April 2007 and June 2009, 125 patients were referred from the State Health Department of Rio de Janeiro for the treatment of confirmed, probable, or suspected PSAM. RESULTS: Laparoscopic cholecystectomy was the most frequent surgical procedure (48.8%) among patients. Clarithromycin, ethambutol, and terizidone were used to treat 113 patients for a mean duration of 226 days. CONCLUSIONS: Despite the need for multidrug therapy and long treatment duration, most included patients adhered to treatment and experienced cure without relapse.


Assuntos
Complicações Pós-Operatórias/etiologia , Infecção da Ferida Cirúrgica/etiologia , Cirurgia Vídeoassistida/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Claritromicina/uso terapêutico , Quimioterapia Combinada , Etambutol/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa , Complicações Pós-Operatórias/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adulto Jovem
8.
World J Gastroenterol ; 25(25): 3183-3195, 2019 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-31333310

RESUMO

Helicobacter pylori (H. pylori) is the causative agent of gastritis, peptic ulcer disease, mucosa associated lymphoid tissue lymphoma and gastric cancer (GC). While this bacterium infects 50% of the world's population, in Africa its prevalence reach as high as 80% as the infection is acquired during childhood. Risk factors for H. pylori acquisition have been reported to be mainly due to overcrowding, to have infected siblings or parent and to unsafe water sources. Despite this high H. pylori prevalence there still does not exist an African guideline, equivalent to the Maastricht V/Florence Consensus Report of the European Helicobacter and Microbiota Study Group for the management of this infection. In this continent, although there is a paucity of epidemiologic data, a contrast between the high prevalence of H. pylori infection and the low incidence of GC has been reported. This phenomenon is the so-called "African Enigma" and it has been hypothesized that it could be explained by environmental, dietary and genetic factors. A heterogeneity of data both on diagnosis and on therapy have been published. In this context, it is evident that in several African countries the increasing rate of bacterial resistance, mainly to metronidazole and clarithromycin, requires continental guidelines to recommend the appropriate management of H. pylori. The aim of this manuscript is to review current literature on H. pylori infection in Africa, in terms of prevalence, risk factors, impact on human health, treatment and challenges encountered so as to proffer possible solutions to reduce H. pylori transmission in this continent.


Assuntos
Antibacterianos/farmacologia , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/patogenicidade , Neoplasias Gástricas/epidemiologia , África/epidemiologia , Antibacterianos/uso terapêutico , Claritromicina/farmacologia , Claritromicina/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Gastroenterologia/normas , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/isolamento & purificação , Humanos , Incidência , Metronidazol/farmacologia , Metronidazol/uso terapêutico , Guias de Prática Clínica como Assunto , Prevalência , Fatores de Risco , Neoplasias Gástricas/microbiologia , Neoplasias Gástricas/prevenção & controle
9.
Artigo em Inglês | MEDLINE | ID: mdl-31336722

RESUMO

Background: Idiopathic facial aseptic granuloma (IFAG) is a rare skin disease that typically presents in children with one or more nontender, erythematous to violaceous nodules located on the cheeks or eyelids. Lesions are not accompanied by other skin abnormalities. IFAG remains a diagnostic challenge in pediatric dermatology, because several diseases may present with similar signs. Case presentation: A three-year-old girl with a previous negative clinical history was referred to our hospital for the evaluation of some asymptomatic nodules on the convexity of the left cheek. The nodules had appeared two months before, and had gradually increased in size. Her mother denied any association with trauma or insect bites. The nodules had a hard-elastic consistency, were moderately firm, and were not fluctuant. No associated lymphadenopathy was observed. The girl was afebrile and in good general condition. A histologic evaluation of a biopsy specimen revealed an inflammatory, granulomatous-diffuse infiltrate in the superficial and deep dermis consisting of giant cells, histiocytes, lymphocytes, neutrophils, eosinophils, and plasma cells. The Ziehl-Neelsen stains, Gram-stains, and cultures were negative. Suspecting an IFAG, treatment with topical fusidic acid and oral clarithromycin for 14 days was started. After two months, the lesion resolved and did not recur. Conclusion: This case shows how to differentiate IFAG from other dermatologic diseases associated with a negative evolution. Treatment with oral clarithromycin was effective in our patient. However, more scientific evidence is needed to evaluate the most suitable antibiotic therapy. Further studies are also needed to establish whether antibiotics actually impact IFAG prognosis.


Assuntos
Bochecha/patologia , Granuloma/diagnóstico , Antibacterianos/uso terapêutico , Pré-Escolar , Claritromicina/uso terapêutico , Diagnóstico Diferencial , Feminino , Ácido Fusídico/uso terapêutico , Granuloma/patologia , Humanos , Pele/patologia
10.
Int J Infect Dis ; 85: 67-69, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31150843

RESUMO

Bystander selection has been shown to result in strong population-level correlations between the level of antimicrobial consumption in the general population and resistance to that antimicrobial or similar antimicrobials in a range of bacteria. The prevalence of clarithromycin resistance in Helicobacter pylori has been increasing rapidly resulting in increased difficulty to eradicate this infection. Using country- and WHO-world-region-level macrolide resistance data from a systematic review and macrolide consumption data from the MIDAS Quantum data base, we tested the hypothesis that the prevalence of clarithromycin resistance was correlated with macrolide consumption. At a country level, we found these variables to be positively correlated (Spearman's rho=0.49; P=0.007). Whilst positive, the correlation between macrolide consumption and primary resistance was not statistically significant at world region level (Spearman's rho=0.95; P=0.05).


Assuntos
Claritromicina/uso terapêutico , Helicobacter pylori/efeitos dos fármacos , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Infecções por Helicobacter/tratamento farmacológico , Humanos , Macrolídeos/uso terapêutico
11.
Intern Med ; 58(18): 2675-2678, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31178483

RESUMO

Mycobacterium abscessus subspecies abscessus is major subspecies in the M. abscessus complex and is usually refractory to standard antibiotherapy. Genetic tracing of erm (41) T28 is a mechanism for monitoring macrolide resistance. We treated a patient with a pulmonary infection caused by M. abscessus subsp. abscessus with the erm (41) T28 polymorphism, which was susceptible to clarithromycin, and his clinical treatment course was good. The identification of the M. abscessus complex genotype is important, but clinical confirmation of clarithromycin susceptibility is also needed to plan individual treatment strategies.


Assuntos
Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Farmacorresistência Bacteriana/genética , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Mycobacterium abscessus/genética , Tuberculose Pulmonar/tratamento farmacológico , Genótipo , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/microbiologia , Fenótipo , Tuberculose Pulmonar/microbiologia
12.
Comp Immunol Microbiol Infect Dis ; 64: 99-108, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31174707

RESUMO

Chronic infection with Helicobacter pylori (H. pylori) is a known risk factor for gastric cancer. Eradication rate of H. pylori infection by the classic triple treatment of PPIs and antibiotics is low. Therefore, probiotics are a useful tool for improving the rate of eradication and reduction of side effects. Several studies in animal models showed that Lactobacillus spp. alone and in combination with other probiotic strains have inhibitory effects on growth and suppression of inflammatory responses in H. pylori infections. However, some studies showed significant effects of Pediococcus strains on suppression, survival, and eradication of H. pylori infections. Therefore, it is suggested that in the treatment of H. pylori infections along with the usual probiotic strains, different strains of Pediococcus could be used. Recent studies showed that Lactobacillus reuteri and Lactobacillus gasseri alone with PPIs in human have a high eradication effect on H. pylori infections and it is suggested as the probiotic treatment of patient's in future therapeutic protocols. In relation to the probiotic treatment process, it should not be recommended that probiotics could be used as a single treatment for H. pylori eradication. However, use of probiotics as a supplement will increase eradication and reduce side effects associated with treatment. It is widely believed that probiotics could improve the eradication of H. pylori and reduce side effects during standard treatment, but some probiotic bacterial species could be useful with drug therapy. Generally, probiotic supplements could increase the eradication rate of H. pylori infections and reduced the side effects of antibiotics.


Assuntos
Suplementos Nutricionais , Infecções por Helicobacter/terapia , Probióticos/uso terapêutico , Animais , Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Ensaios Clínicos como Assunto , Modelos Animais de Doenças , Quimioterapia Combinada , Helicobacter pylori , Humanos , Resultado do Tratamento
13.
BMC Infect Dis ; 19(1): 546, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226948

RESUMO

BACKGROUND: The effectiveness of Helicobacter pylori first-line treatment has decreased drastically with the rise of strains resistant to clarithromycin. Therapy failure has also been described in patients with infections by strains with dissimilar antimicrobial susceptibilities. The present study aims to estimate the prevalence of resistance and heteroresistance to clarithromycin in H. pylori isolates from antrum and corpus of Colombian patients. METHODS: The study material included 126 isolates from antrum and corpus biopsies from 63 symptomatic patients over 18 years old who had a gastric endoscopy performed on them between June 2014 to August 2016. PCR amplification and sequencing of the H. pylori 23S rDNA gene was performed to determine the presence of mutations associated with clarithromycin resistance. Random amplified polymorphic DNA analysis was implemented in cases of resistance and heteroresistance. RESULTS: The overall frequency of resistance to clarithromycin was 38.1% (24/63 patients), of which 19 patients had resistant isolates in both stomach segments (14 with A2143G mutation and 5 with A2142G mutation), and 5 patients had a heteroresistant status. The remaining 61.9% (39/63 patients) presented only susceptible isolates. DNA fingerprinting analysis showed different patterns in 4/22 paired isolates. CONCLUSIONS: The high prevalence of H. pylori clarithromycin-resistance obtained (> 15%) constitutes an alert for gastroenterologists and suggests the need for reconsideration of the current eradication regimen for H. pylori in the studied population. The data show that heteroresistance status is an additional factor to be considered in the assessment of resistance. In consequence, it is advisable to examine at least two biopsies from different gastric segments.


Assuntos
Técnicas de Tipagem Bacteriana , Claritromicina/uso terapêutico , Farmacorresistência Bacteriana/genética , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/microbiologia , Helicobacter pylori , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Claritromicina/farmacologia , Colômbia/epidemiologia , Feminino , Genótipo , Técnicas de Genotipagem , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/patologia , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/genética , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mutação , Reação em Cadeia da Polimerase/métodos , Prevalência , Antro Pilórico/microbiologia , Antro Pilórico/patologia , Estômago/microbiologia , Estômago/patologia , Adulto Jovem
14.
Pediatr Dermatol ; 36(4): e93-e94, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31042815

RESUMO

Up to 1.3 million children from the former Soviet Union (fSU) and Eastern Europe have been placed in institutional care worldwide. With the hope of ensuring the child's health in the immediate post-adoption period, these children are known to receive many injections of vaccines, vitamins, and medications, many unnecessary and often administered with unsafe technique. This practice can lead to formation of suppurative granulomas in these children. Though rare, dermatologists should be aware of these conditions in adoptees from Eastern Europe.


Assuntos
Abscesso/tratamento farmacológico , Abscesso/etiologia , Granuloma/etiologia , Dermatopatias/tratamento farmacológico , Dermatopatias/etiologia , Abscesso/fisiopatologia , Criança Adotada/estatística & dados numéricos , Claritromicina/uso terapêutico , Europa Oriental , Feminino , Granuloma/tratamento farmacológico , Granuloma/fisiopatologia , Humanos , Lactente , Injeções Intramusculares/efeitos adversos , Rifampina/uso terapêutico , Medição de Risco , Federação Russa , Dermatopatias/fisiopatologia , U.R.S.S.
15.
Int J Pediatr Otorhinolaryngol ; 122: 196-202, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31039497

RESUMO

OBJECTIVES: Nontuberculous mycobacterial (NTM) lymphadenitis is a rare disease of children under 5 years. Its treatment is not standardized, even a "wait-and-see" approach is shown to be effective in the literature. Here, we discuss the diagnostic and therapeutic strategies employed in our departments. METHODS: Records of pediatric patients treated for NTM cervical lymphadenitis from 2010 to 2015 in our tertiary center were retrospectively reviewed. Patients underwent cervical echotomography and/or CT scan. Every patient but one had microbiological explorations (NTM polymerase chain reaction [PCR] and culture) on fine needle aspiration of pus and/or adenitis biopsy. Differential diagnoses (tuberculosis, cat scratch disease) were excluded with serologies, chest X-Ray, and PCR on adenitis samples. Patients were classified as "proven diagnosis" (NTM detected), "highly probable" (suggestive clinical and anatomopathological aspect) or "possible" infection (suggestive adenitis alone). Treatments, follow-up and adverse events were reviewed. RESULTS: Thirty-one patients were treated for NTM, median age 2.40 years (Interquartile Range IQR = [1.85-3.16]). Twenty-nine patients (96.77%) had an isolated cervico-facial localization. Median follow-up was 8.00 months (IQR = [4.20-13.43]). We found 17 "proven diagnosis" (58.62%), 5 "highly probable" (17.24%) and 7 "possible" infections (24.14%). "Proven" infections were due to: Mycobacterium avium (n = 12, 66.67%) and M. intracellulare (n = 5, 27.78%). All 29 patients received antibiotics, which were effective for 10 (34.48%, group 1); 10 underwent surgical excision for a poor outcome with antibiotics (34.48%, group 2); spontaneous or surgical drainage occurred in 9 on antibiotics (31.03%, group 3). The median times to resolution for group 1, 2 and 3 were respectively 6.33 months, 6.22 months and 9.53 months. Antibiotics treatment was mostly clarithromycin (n = 27, 93.10%) and/or rifampicin (n = 19, 65.52%); 18 patients (62.07%) received both. Median antibiotics duration was 6.23 months (IQR = [5.17-7.46]), with good compliance (79.31%). The observed adverse effects were 3 (13.04%) isolated transient transaminase elevations, 1 case (4.35%) of minor creatinine elevation, and 1 case (4.35%) of transient diarrhea. Surgical drainage caused 1 transient marginal mandibular nerve palsy, resolutive after 1 month. CONCLUSION: Antibiotics in NTM adenitis lead to resolution in 7 months, with good tolerance and compliance. The efficacy of "wait-and-see" attitude in the literature make excision surgery a second line treatment.


Assuntos
Antibacterianos/uso terapêutico , Linfadenite/tratamento farmacológico , Linfadenite/microbiologia , Infecções por Micobactéria não Tuberculosa/diagnóstico , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Antibacterianos/efeitos adversos , Antibióticos Antituberculose/uso terapêutico , Pré-Escolar , Claritromicina/uso terapêutico , Drenagem/efeitos adversos , Quimioterapia Combinada , Feminino , Humanos , Lactente , Linfadenite/cirurgia , Masculino , Infecções por Micobactéria não Tuberculosa/complicações , Infecções por Micobactéria não Tuberculosa/microbiologia , Mycobacterium avium , Complexo Mycobacterium avium , Pescoço , Estudos Retrospectivos , Rifampina/uso terapêutico
16.
Isr Med Assoc J ; 5(21): 339-344, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31140227

RESUMO

BACKGROUND: The prevalence of Helicobacter pylori varies geographically by age, race, and socioeconomic status (SES). However, the impact of ethnicity on endoscopic outcomes in infected individuals is not well known. OBJECTIVES: To assess the impact of ethnicity among Israelis with biopsy-proven H. pylori infection. METHODS: A retrospective study, including patients who underwent gastroscopy and were diagnosed histologically with H. pylori infection, was conducted. Information on demographics, SES, medications, and co-morbidities were extracted from medical records. Univariate (Student's t-test, chi-square test) and multivariate (multinomial and logistic) regression analysis were conducted to examine the predictors of the clinical outcome. RESULTS: The study included 100 Israeli Jews and 100 Israeli Arabs diagnosed with biopsy-proven H. pylori infection. At univariate analysis, the number of households was higher among Arabs (P < 0.001), whose family income and parental education were lower than among Jews (P < 0.001 for both variables). The response to amoxicillin and clarithromycin differed between the two groups, being higher among Jews (P < 0.001).In clinical outcomes (gastritis severity, gastric and duodenal ulcer, intestinal metaplasia, atrophic gastritis, and MALT), no statistically significant differences could be detected between Jews and Arabs. Concerning intestinal metaplasia, lack of consumption of nonsteroidal anti-inflammatory drugs resulted a statistically significant protective factor (odds ratio 0.128, 95% confidence interval 0.024-0.685, P = 0.016). CONCLUSIONS: Although in the literature ethnicity seems to be a risk factor for H. pylori colonization, no statistical significance was detected in various endoscopic and histological findings related to H. Pylori infection between Israeli Arabs and Jews.


Assuntos
Amoxicilina/uso terapêutico , Claritromicina/uso terapêutico , Mucosa Gástrica , Gastrite , Gastroscopia , Infecções por Helicobacter , Helicobacter pylori/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Árabes/estatística & dados numéricos , Biópsia/métodos , Biópsia/estatística & dados numéricos , Demografia , Feminino , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Gastrite/etnologia , Gastrite/patologia , Gastrite/fisiopatologia , Gastroscopia/métodos , Gastroscopia/estatística & dados numéricos , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/etnologia , Infecções por Helicobacter/patologia , Infecções por Helicobacter/fisiopatologia , Humanos , Israel/epidemiologia , Judeus/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos
17.
BMC Infect Dis ; 19(1): 447, 2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31113384

RESUMO

BACKGROUND: Helicobacter pylori (H.pylori) infection is a common medical problem in resource limited areas. The treatment outcome after triple therapy has not been well studied in developing countries and preliminary data suggests a high rate of treatment failure. This study investigated the triple therapy treatment failure rate and associated factors among dyspeptic patients receiving H. pylori first line therapy at a tertiary hospital, Tanzania. METHODS: A prospective study in the Gastroenterology unit of the Bugando Medical Centre (BMC) was conducted between October 2015 and May 2017. All dyspeptic patients with stool antigen tests positive for H.pylori were given first line therapy, and stool antigen testing was repeated within 7 days and 5 weeks after completion of the treatment. Biopsies were taken before initiation of therapy and analysed for clarithromycin and quinolone resistance mutations using polymerise chain reaction (PCR) and sequencing. Adherence and other social-demographic characteristics were documented. RESULTS: A total of 210 patients were enrolled; the median age was 35 years (interquartile range, 27-48). First line treatment failure as defined by positive stool antigen 5 weeks post treatment was observed in 65/210 (31%) of patients. Independent predictors of first line treatment failure were presence of clarithromycin resistance mutations (OR: 23.12, 95% CI (9.38-56.98), P < 0.001) and poor adherence (OR: 7.39, 95% CI (3.25-16.77), P < 0.001). The sensitivity and specificity of stool antigen testing within 7 days after completion therapy in detecting treatment failure was 100 and 93.2%, respectively. CONCLUSION: Nearly one-third of patients with clarithromycin resistance mutations and poor adherence develop first line treatment failure. Routine stool antigen testing within seven days after completion of therapy can be considered in order to initiate second line treatment early to prevent associated morbidities.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Adulto , Claritromicina/uso terapêutico , Quimioterapia Combinada , Fezes/microbiologia , Feminino , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/psicologia , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/genética , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Estudos Prospectivos , Quinolonas/uso terapêutico , Tanzânia/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Falha de Tratamento , Adulto Jovem
18.
Gastroenterology ; 157(1): 44-53, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30998990

RESUMO

Increasing resistance to antibiotics worldwide has adverse effects on the effectiveness of standard therapies to eradicate Helicobacter pylori infection. We reviewed guidelines developed by expert groups in Europe, Canada, and the United States for the treatment of H pylori infection. We compared the recommendations of these guidelines, reconciled them, and addressed the increasing resistance of H pylori to antibiotic therapy regimens. The guidelines recommend bismuth quadruple therapy for first-line treatment, replacing clarithromycin-based triple therapy. There is consensus for concomitant 4-drug therapy as an alternative, especially when bismuth is not available. When therapy is unsuccessful, it is likely due to resistance to clarithromycin, levofloxacin, and/or metronidazole; these drugs, if used previously, should be avoided in subsequent eradication attempts. Second-line therapies should be bismuth quadruple therapy or levofloxacin triple therapy, depending on suspected resistance, reserving rifabutin-based triple and high-dose dual amoxicillin proton pump inhibitor therapy for subsequent treatment attempts. The increasing resistance of H pylori to antibiotic therapy necessitates local availability of susceptibility tests for individuals, and establishment of regional and national monitoring programs to develop evidence-based locally relevant eradication strategies. Further studies into the development of more easily accessible methods of resistance testing, such as biomarker analysis of stool samples, are required. Options under investigation include substituting vonoprazan for proton pump inhibitors, adding probiotics, and vaccine development. Narrow-spectrum antibiotics and new therapeutic targets could be identified based on genomic, proteomic, and metabolomic analyses of H pylori.


Assuntos
Antiácidos/uso terapêutico , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Guias de Prática Clínica como Assunto , Inibidores da Bomba de Prótons/uso terapêutico , Amoxicilina/uso terapêutico , Bismuto/uso terapêutico , Canadá , Claritromicina/uso terapêutico , Quimioterapia Combinada , Europa (Continente) , Infecções por Helicobacter , Helicobacter pylori , Humanos , Levofloxacino/uso terapêutico , Metronidazol/uso terapêutico , Testes de Sensibilidade Microbiana , Rifabutina/uso terapêutico , Tetraciclina/uso terapêutico , Estados Unidos
19.
Helicobacter ; 24(3): e12584, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30990575

RESUMO

BACKGROUND: Susceptibility-guided treatment has been proposed as a way to improve Helicobacter pylori eradication rates. Evidence on its efficacy for rescue therapy is very scarce. The aim of this study was to indirectly assess the applicability and effectiveness of susceptibility-guided treatment by evaluating (a) the rate of acceptance of endoscopy, (b) its success in detecting resistances, and (c) infection cure rates in patients harboring strains found to be susceptible to the antibiotics administered in clinical trials in which the efficacy of second-line treatments was reported. METHODS: A systematic review of studies evaluating second-line H pylori treatment was carried out in multiple databases. Studies reporting antibiotic susceptibility evaluation and/or cure rates in patients harboring sensitive and resistant strains were selected. Data were extracted in duplicate. RESULTS: The systematic review identified 36 eligible studies. Acceptance was evaluated in only one study of 60 patients, of whom only 38 agreed to endoscopy. Among the 2890 patients who received endoscopy and culture, resistances were finally determined in 86.5%. Cure rate was 72.5% in the 113 patients harboring a clarithromycin-susceptible strain after previous clarithromycin treatment, 93.5% in the 765 patients harboring a metronidazole-susceptible strain, and 83.8% in the 192 patients harboring a levofloxacin-susceptible strain. No studies with repeated administration of levofloxacin or metronidazole were found. CONCLUSION: Even if the culture shows a clarithromycin-sensitive strain, repeating clarithromycin after a first failure should be discouraged. Susceptibility-guided treatment alone did not achieve adequate cure rates for rescue therapies. Additional measures are needed to design rescue treatments that consistently achieve excellent cure rates.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Amoxicilina/uso terapêutico , Claritromicina/uso terapêutico , Endoscopia , Infecções por Helicobacter/microbiologia , Humanos , Levofloxacino/uso terapêutico , Metronidazol/uso terapêutico , Resultado do Tratamento
20.
Dermatol Online J ; 25(3)2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30982309

RESUMO

A sporotrichoid pattern describes a clinical presentation in which inflammatory nodules spread along the path of lymphatic drainage, being reported in association with several infectious, neoplastic, and inflammatory skin conditions. Herein, we report a 65-year-old man presenting with a three-month history of erythematous nodules in a linear distribution along the left hand and forearm. He reported recent rose gardening and regular contact with an aquarium. The diagnosis was made through culture of skin biopsy tissue and isolation of Mycobacterium marinum. The patient was treated with a combination of clarithromycin and rifampicin and clinical resolution was evident within two months. We present a patient with a sporotrichoid cutaneous infection by Mycobacterium marinum, highlighting that even with the availability of novel microbiological detection techniques, tissue culture remains an essential tool for diagnostic confirmation.


Assuntos
Infecções por Micobactéria não Tuberculosa/diagnóstico , Dermatopatias Bacterianas/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Biópsia , Claritromicina/uso terapêutico , Técnicas de Cultura , Antebraço , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/patologia , Humanos , Masculino , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Infecções por Micobactéria não Tuberculosa/patologia , Rifampina/uso terapêutico , Dermatopatias Bacterianas/tratamento farmacológico , Dermatopatias Bacterianas/patologia
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