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1.
Ann Intern Med ; 177(6): JC67, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38830223

RESUMO

SOURCE CITATION: Wagenlehner F, Perry CR, Hooton TM, et al. Oral gepotidacin versus nitrofurantoin in patients with uncomplicated urinary tract infection (EAGLE-2 and EAGLE-3): two randomised, controlled, double-blind, double-dummy, phase 3, non-inferiority trials. Lancet. 2024;403:741-755. 38342126.


Assuntos
Nitrofurantoína , Infecções Urinárias , Humanos , Nitrofurantoína/uso terapêutico , Feminino , Infecções Urinárias/tratamento farmacológico , Método Duplo-Cego , Anti-Infecciosos Urinários/uso terapêutico , Adulto , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Acenaftenos
3.
Antimicrob Agents Chemother ; 68(7): e0024224, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38767379

RESUMO

Nitrofurantoin resistance in Escherichia coli is primarily caused by mutations damaging two enzymes, NfsA and NfsB. Studies based on small isolate collections with defined nitrofurantoin MICs have found significant random genetic drift in nfsA and nfsB, making it extremely difficult to predict nitrofurantoin resistance from whole-genome sequence (WGS) where both genes are not obviously disrupted by nonsense or frameshift mutations or insertional inactivation. Here, we report a WGS survey of 200 oqxAB-negative E. coli from community urine samples, of which 34 were nitrofurantoin resistant. We characterized individual non-synonymous mutations seen in nfsA and nfsB among this collection using complementation cloning and NfsA/B enzyme assays in cell extracts. We definitively identified R203C, H11Y, W212R, A112E, and A112T in NfsA and R121C, Q142H, F84S, P163H, W46R, K57E, and V191G in NfsB as amino acid substitutions that reduce enzyme activity sufficiently to cause resistance. In contrast, E58D, I117T, K141E, L157F, A172S, G187D, and A188V in NfsA and G66D, M75I, V93A, and A174E in NfsB are functionally silent in this context. We identified that 9/166 (5.4%) nitrofurantoin-susceptible isolates were "pre-resistant," defined as having loss of function mutations in nfsA or nfsB. Finally, using NfsA/B enzyme assays and proteomics, we demonstrated that 9/34 (26.5%) ribE wild-type nitrofurantoin-resistant isolates also carried functionally wild-type nfsB or nfsB/nfsA. In these cases, NfsA/B activity was reduced through downregulated gene expression. Our biological understanding of nitrofurantoin resistance is greatly improved by this analysis but is still insufficient to allow its reliable prediction from WGS data.


Assuntos
Proteínas de Escherichia coli , Escherichia coli , Testes de Sensibilidade Microbiana , Nitrofurantoína , Nitrorredutases , Sequenciamento Completo do Genoma , Nitrofurantoína/farmacologia , Escherichia coli/genética , Escherichia coli/efeitos dos fármacos , Proteínas de Escherichia coli/genética , Sequenciamento Completo do Genoma/métodos , Nitrorredutases/genética , Nitrorredutases/metabolismo , Farmacorresistência Bacteriana/genética , Mutação , Humanos , Anti-Infecciosos Urinários/farmacologia , Antibacterianos/farmacologia , Genoma Bacteriano/genética
4.
APMIS ; 132(7): 492-498, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38558445

RESUMO

The antimicrobial agent nitrofurantoin is becoming increasingly important for treatment of urinary tract infections (UTIs) due to widespread occurrence of multidrug-resistant Escherichia coli. Despite many years of use, little data on nitrofurantoin pharmacokinetics (PK) or -dynamics (PD) exist. The objective of this study was to (i) evaluate the pharmacokinetics of nitrofurantoin in a mouse model and (ii) use that data to design an in vivo dose fractionation study in an experimental model of UTI with E. coli for determination of the most predictive PK/PD index. Nitrofurantoin concentrations in urine were approximately 100-fold larger than concentrations in plasma after oral administration of 5, 10, and 20 mg/kg nitrofurantoin. The area under the curve over the minimum inhibitory concentration (AUC/MIC) was weakly correlated to bacterial reduction in urine (r2 = 0.24), while no such correlation was found for the time that nitrofurantoin stayed above the MIC (T > MIC). Increasing size of single-dose treatment was significantly correlated to eradication of bacteria in the urine, while this was not apparent when the same doses were divided in 2 or 3 doses 8 or 12 h apart. In conclusion, the results indicate that nitrofurantoin activity against E. coli in urine is driven by AUC/MIC.


Assuntos
Modelos Animais de Doenças , Infecções por Escherichia coli , Escherichia coli , Testes de Sensibilidade Microbiana , Nitrofurantoína , Infecções Urinárias , Nitrofurantoína/farmacocinética , Nitrofurantoína/farmacologia , Nitrofurantoína/uso terapêutico , Animais , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Escherichia coli/efeitos dos fármacos , Camundongos , Feminino , Anti-Infecciosos Urinários/farmacocinética , Anti-Infecciosos Urinários/farmacologia , Anti-Infecciosos Urinários/uso terapêutico , Anti-Infecciosos Urinários/administração & dosagem , Antibacterianos/farmacocinética , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Administração Oral
6.
Microbiol Spectr ; 12(1): e0307923, 2024 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-38063385

RESUMO

IMPORTANCE: Antimicrobial resistance (AMR) poses a global threat and requires the exploration of underestimated treatment options. Nitroxoline, an effective broad-spectrum antibiotic, does not suffer from high resistance rates in the clinics but surprisingly, it is not heavily used yet. Our findings provide compelling evidence that Nitroxoline resistance renders bacteria unable to cause an infection in vivo, thereby reinvigorating the potential of Nitroxoline in combating AMR.


Assuntos
Infecções por Escherichia coli , Nitroquinolinas , Infecções Urinárias , Humanos , Escherichia coli , Anti-Infecciosos Urinários , Infecções Urinárias/microbiologia , Virulência , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia
7.
Eur J Clin Pharmacol ; 79(8): 1043-1049, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37266591

RESUMO

PURPOSE: The aim of this study is to determine nitrofurantoin exposure in female patients with different age and renal function with complaints of an uncomplicated UTI. Also the nitrofurantoin exposure in relation to the dosage regimen will be studied. METHODS: Eight general practitioners (GP) participated in the study and included 38 patients with symptoms of an uncomplicated UTI, treated either with a dose of 50 mg q6h or 100 mg q12h, upon the discretion of the GP. Nitrofurantoin exposure was quantified in the patient's 24-h urine samples by UHPLC-UV and the area under the curve was calculated. RESULTS: The 38 patients provided a range of 2-17 urine samples. The urine nitrofurantoin exposure was 1028 mg h/L for the patients receiving 50 mg q6h and 1036 mg h/L for those treated with 100 mg q12h (p = 0.97) and was not affected by age and eGFR (p = 0.64 and p = 0.34, respectively). CONCLUSION: The data obtained do not support the discouragement of nitrofurantoin use in the elderly and in patients with impaired renal function. Since only a small number of patients were included, a larger study with more patients is warranted to evaluate nitrofurantoin exposure and adverse effects.


Assuntos
Insuficiência Renal , Infecções Urinárias , Humanos , Feminino , Idoso , Nitrofurantoína/efeitos adversos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/induzido quimicamente , Infecções Urinárias/urina , Protocolos Clínicos , Insuficiência Renal/tratamento farmacológico , Rim/fisiologia , Anti-Infecciosos Urinários/efeitos adversos , Antibacterianos/efeitos adversos
9.
J Small Anim Pract ; 64(7): 477-484, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36971090

RESUMO

OBJECTIVES: To report the protocol, efficacy and adverse events in dogs receiving nightly nitrofurantoin therapy as antimicrobial prophylaxis for recurrent urinary tract infections. MATERIALS AND METHODS: Retrospective case series of dogs prescribed nitrofurantoin as prophylaxis for recurrent urinary tract infections. Data on urological history, diagnostic investigation, protocol, adverse events and efficacy (through serial urine cultures) were extracted from medical records. RESULTS: Thirteen dogs were included. Before therapy, dogs had a median of 3 (range 3 to 7) positive urine cultures in the past year. In all but one dog, standard antimicrobial therapy was given before starting the nightly nitrofurantoin. The nightly nitrofurantoin was then prescribed at a median dose of 4.1 mg/kg orally every 24 hours for a median of 166 days (range 44 to 1740). The median infection-free interval on therapy was 268 days (95% confidence interval: 165 to undefined). Eight dogs had no positive urine cultures while on therapy. Of these, five (three which discontinued and two which remained on nitrofurantoin) had no return of clinical signs or bacteriuria at time of last follow-up evaluation or death, and three had suspected or confirmed bacteriuria 10 to 70 days after discontinuation. Five dogs developed bacteriuria on therapy, four of which were nitrofurantoin-resistant Proteus spp. Most other adverse events were minor; none were considered likely caused by the drug on causality assessment. CLINICAL SIGNIFICANCE: Based on this small study group, nightly nitrofurantoin appears well tolerated and might be efficacious prophylaxis for recurrent urinary tract infections in dogs. Infection with nitrofurantoin-resistant Proteus spp. was a common reason for treatment failure.


Assuntos
Bacteriúria , Doenças do Cão , Infecções Urinárias , Cães , Animais , Nitrofurantoína/efeitos adversos , Bacteriúria/induzido quimicamente , Bacteriúria/tratamento farmacológico , Bacteriúria/veterinária , Anti-Infecciosos Urinários/efeitos adversos , Estudos Retrospectivos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/prevenção & controle , Infecções Urinárias/veterinária , Doenças do Cão/tratamento farmacológico , Doenças do Cão/prevenção & controle , Doenças do Cão/induzido quimicamente
11.
Ann. afr. méd. (En ligne) ; 16(2): 5099-5103, 2023. figures, tables
Artigo em Francês | AIM (África) | ID: biblio-1425959

RESUMO

Contexte et objectifs. La sonde double J est très utilisée de nos jours dans le drainage des urines du haut appareil. L'objectif de la présente étude était de décrire le devenir de la pose de la sonde double J. Méthodes. Il s'est agi d'une étude documentaire d'une série des cas ayant bénéficié d'un drainage urinaire du haut appareil par une sonde double J au Centre National Hospitalo-Universitaire Hubert Koutoukou Maga de Cotonou, Bénin ; entre les 1er avril 2018 et 31 mars 2021. Résultats. Les dossiers de cent trois patients (âge moyen 48,4 ans, sexe masculin, 58,3 %) ont été colligés. La pose de la sonde double J représentait 84,74 %. La pose de la sonde double J était unilatérale dans 76,7 % des cas avec une prédominance à droite (56,0 %). L'abord par voie endoscopique pour la pose de la sonde double J était la plus pratiquée (89,3 %). La pose de la sonde double J a été effectuée sans guidage fluoroscopique (à l'aveugle) dans 73,7 % et la durée moyenne du port de cette sonde était 118,37 jours. La fonction rénale était perturbée avec un débit de filtration glomérulaire < 60 ml/minute/1,75 m2 chez 33,0 % des patients. Les étiologies à la base d'une obstruction étaient dominées par la pathologie lithiasique (63,1 %). Le taux de réussite de la sonde double J était de 77,6 %. Les échecs de la sonde double J étaient dus aux pathologies tumorales dans 15,53 %. La durée moyenne d'hospitalisation après la pose de la sonde double J par voie endoscopique était de 7,72 jours. Conclusion. Le syndrome obstructif surtout d'origine lithiasique reste la plus importante indication de l'usage de la sonde double J. Sa réalisation sans guidage fluoroscopique (à l'aveugle) est possible dans le milieu ne disposant pas d'amplificateur de brillance.


Assuntos
Humanos , Urologia , Andrologia , Endoscopia , Enfermagem em Nefrologia , Anti-Infecciosos Urinários
12.
Crit Rev Ther Drug Carrier Syst ; 39(5): 51-82, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35993996

RESUMO

Three-dimensional (3D) printing is a pioneering technology that has gained increased popularity in the fields of tissue engineering, drug design, drug delivery systems and biomedical devices. Thus, it enables us to explore this technique for fabricating 3D-printed catheters. Owing to its enhanced productivity and cost-efficiency, this technique can be utilized to fabricate any material for manufacturing or designing catheters with antimicrobial properties. From 1930s, Foley's catheter had been widely used to drain the urinary bladder of patients with impaired bladder function. Despite the complications like catheter-associated urinary tract infections (CAUTIs), kidney damage, chronic infections, encrustations and personal discomfort during inflation of the balloon, Foley's catheter was used universally without any changes in product design. Currently, marketed catheters have been reported for reducing CAUTI, but the prevention of limitations by coating drugs onto the catheter is very expensive. Altering the physical properties of the catheter by biopolymer blend might ease the discomfort. Thus, new technologies have to be adopted to manufacture ideal catheters that are biocompatible and provide antimicrobial and anti-fouling properties. Herein, we provide an overview of 3D printing techniques along with different materials opted for manufacturing catheters to overcome the existing challenges and limitations.


Assuntos
Anti-Infecciosos , Infecções Relacionadas a Cateter , Infecções Urinárias , Antibacterianos/uso terapêutico , Anti-Infecciosos Urinários , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/prevenção & controle , Humanos , Impressão Tridimensional , Cateteres Urinários/efeitos adversos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
14.
Clin Microbiol Infect ; 28(2): 248-254, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34111584

RESUMO

OBJECTIVES: Guidelines do not distinguish between 50 mg or 100 mg nitrofurantoin as daily prophylaxis for recurrent urinary tract infection (UTI), although 50 mg might have a better safety profile. Our objective was to compare the effectiveness and safety of both regimens. METHODS: Data were retrospectively collected from 84 Dutch GP practices between 2013 and 2020. Nitrofurantoin prescriptions of 100 mg and 50 mg every 24 hours in women were included. Cox proportional hazard regression analysis was used to calculate hazard ratios on first episode of UTI, pyelonephritis and (adverse) events. Patients were followed for the duration of consecutive repeated prescriptions, assuming non-informative right censoring, up to 1 year. RESULTS: Nitrofurantoin prophylaxis was prescribed in 1893 patients. Median lengths of follow up were 90 days (interquartile range (IQR) 37-179 days) for 100 mg (n = 551) and 90 days (IQR 30-146 days) for 50 mg (n = 1342) with few differences in baseline characteristics between populations. Under 100 mg and 50 mg, 82/551 (14.9%) and 199/1342 (14.8%) developed UTI and 46/551 (8.3%) and 81/1342 (6.0%) developed pyelonephritis, respectively. Adjusted HRs of 100 mg versus 50 mg were 1.01 (95% CI 0.78-1.30) on first UTI, 1.37 (95% CI 0.95-1.98) on first pyelonephritis episode, 1.82 (95% CI 1.20-2.74) on first consultation for cough, 2.68 for dyspnoea (95% CI 1.11-6.45) and 2.43 for nausea (95% CI 1.03-5.74). CONCLUSION: Daily prophylaxis for recurrent UTI with 100 mg instead of 50 mg nitrofurantoin was associated with an equivalent hazard on UTI or pyelonephritis, and a higher hazard on cough, dyspnoea and nausea. We recommend 50 mg nitrofurantoin as daily prophylaxis.


Assuntos
Nitrofurantoína , Infecções Urinárias , Anti-Infecciosos Urinários/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Nitrofurantoína/efeitos adversos , Estudos Retrospectivos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/prevenção & controle
16.
Clin Microbiol Infect ; 28(3): 377-382, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34245906

RESUMO

OBJECTIVE: To compare the effectiveness of 5 versus 7 days of nitrofurantoin treatment for urinary tract infection (UTI) in women with diabetes. METHODS: Data were collected retrospectively from Dutch general practitioners between 2013 and 2020. Nitrofurantoin prescriptions with a duration of 5 days (5DN) or 7 days (7DN) in women with diabetes were included. Inverse propensity weighting was performed to calculate adjusted risk differences (RD) for treatment failure within 28 days. Secondary outcomes were 14-day treatment failure, severe treatment failure and 28-day treatment failure in defined risk groups. RESULTS: Nitrofurantoin was prescribed in 6866 episodes, 3247 (47.3%) episodes with 5DN and 3619 (52.7%) episodes with 7DN. Patients in the 7DN group had more co-morbidities, more diabetes-related complications and were more insulin-dependent. There were 517/3247 (15.9%) failures in the 5DN group versus 520/3619 (14.4%) in the 7DN group. The adjusted RD for failure within 28 days was 1.4% (95% CI -0.6 to 3.4). CONCLUSION: We found no clinically significant difference in treatment failure in women with diabetes with UTI treated with either 5DN or 7DN within 28 days. A 5-day treatment should be considered to reduce cumulative nitrofurantoin exposure in DM patients.


Assuntos
Diabetes Mellitus , Infecções Urinárias , Anti-Infecciosos Urinários/uso terapêutico , Diabetes Mellitus/tratamento farmacológico , Feminino , Humanos , Nitrofurantoína/uso terapêutico , Estudos Retrospectivos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
17.
Acta Med Okayama ; 75(6): 719-724, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34955540

RESUMO

Differentiating patients by age and causative bacterial morphology might aid in making the appropriate choice of antimicrobial agent when treating acute uncomplicated cystitis. In this retrospective analysis, the non-susceptibility rates of the causative bacteria to cefcapene-pivoxil (CFPN-PI) and levofloxacin (LVFX) were determined after dividing patients with acute uncomplicated cystitis by age group (15-54 and 55-74 years old) and by bacterial morphology: gram-positive cocci (GPC) or gram-negative rod (GNR). The overall non-susceptibility rates for CFPN-PI and LVFX were 19.4% and 15.3%, respectively. When the subjects were divided by age, only the non-susceptibility rate for LVFX in the younger group significantly decreased (to 8.7%). When the groups were divided by both age and bacterial morphology, the younger GNR group had non-susceptibility rates of 6.9% to CFPN-PI and 7.8% to LVFX, whereas the younger GPC group showed 10.2% non-susceptibility to LVFX. The older GNR group showed 9.8% non-susceptibility to CFPN-PI, while the older GPC group showed 7.2% non-susceptibility to LVFX. All the non-susceptibility rates were lower than 10.2% in the sub-divided groups. Differentiating patients by age and the morphology of causative bacteria can aid in making the appropriate choice of antimicrobial agent and may improve treatment outcomes in patients with acute uncomplicated cystitis.


Assuntos
Antibacterianos/uso terapêutico , Anti-Infecciosos Urinários/uso terapêutico , Cistite/tratamento farmacológico , Adolescente , Adulto , Fatores Etários , Idoso , Cefalosporinas/uso terapêutico , Cistite/microbiologia , Feminino , Humanos , Levofloxacino/uso terapêutico , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
18.
Bol. malariol. salud ambient ; 61(4): 633-641, dic. 2021. tab, graf
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1395694

RESUMO

La resistencia de antibióticos puede llegar a causar una amplia morbilidad y complicaciones. Objetivo: Determinar el perfil de resistencia antimicrobiana de Escherichia Coli y de Staphylococcus Saprophyticus, en pacientes con infección urinaria hospitalizados en el servicio de Medicina Interna del Hospital Municipal Los Olivos. Métodos: Estudio descriptivo, retrospectivo de corte transversal. Se realizó en el servicio de Medicina Interna del Hospital Municipal los Olivos (HMLO). Participantes: historia clínica de pacientes hospitalizados con infección urinaria en el servicio de Medicina Interna. Intervenciones: Según los criterios de inclusión y exclusión se obtuvieron, 96 historias clínicas (HC) del año 2013. Se utilizó un instrumento de recolección validado. Se realizó el análisis descriptivo con software estadístico STATA versión 25. Resultados: De las 96 HC, la edad promedio fue 55,04 años, los agentes microbianos más frecuentes fueron: la Escherichia coli con 85,3%, Staphylococcus saprophyticus 4.2% y Klebsiella pneumoniae 3,1%. La prevalencia de productores de betalactamasa espectro extendido (BLEE) fue 10,4%. Los antibióticos más resistentes fueron: trimetoprim/sulfametoxazol 89,6%, ampicilina 86%, piperacilina 84,6%, tetraciclina 79,2% y ciprofloxacino 70,8%. Los antibióticos más sensibles fueron: amikacina 100%, imipenem 100%, ertapenem 98%, meropenem 96% y piperacilina/tazobactam 96%. Conclusión: El uropatógeno más frecuente en pacientes con ITU hospitalizados fue la E. coli. Los antibióticos que presentaron resistencia a la E. coli fueron: trimetoprim/sulfametoxazol, ampicilina, piperacilina, tetraciclina y ciprofloxacino, y para el S. Saprophyticus fueron: amoxicilina/ ácido clavulánico, trimetoprim/sulfametoxazol, ceftriaxona y ciprofloxacino(AU)


Resistance to antibiotics may actually cause extensive morbidity and complications. Objective: To determine the antimicrobial resistance profile of Escherichia coli and Staphylococcus saprophyticus, in patients with urinary infection hospitalized in the Internal Medicine service of the Los Olivos Municipal Hospital. Methods: Descriptive, retrospective cross-sectional study. It was carried out in the Internal Medicine service of the Los Olivos Municipal Hospital (HMLO). Participants: clinical history of hospitalized patients with urinary infection in the Internal Medicine service. Interventions: According to the inclusion and exclusion criteria, 96 clinical records (HC) from 2013 were obtained. A validated collection instrument was used. Descriptive analysis was performed with STATA version 25 statistical software. Results: Of the 96 CHs, the average age was 55.04 years, the most frequent microbial agents were: Escherichia Coli with 85.3%, Staphylococcus saprophyticus 4.2% and Klebsiella pneumoniae 3.1%. The prevalence of extended spectrum beta-lactamase producers (ESBL) was 10.4%. The most resistant antibiotics were trimethoprim / sulfamethoxazole 89.6 %, ampicillin 86 %, piperacillin 84.6 %, tetracycline 79.2 % and ciprofloxacin 70.8 %. The most sensitive antibiotics were: amikacin 100%, imipenem 100%, ertapenem 98%, meropenem 96% and piperacillin / tazobactam 96%. Conclusion: The most common uropathogen in hospitalized UTI patients was E. coli. The antibiotics that showed resistance to E. coli were: trimethoprim/sulfamethoxazole, ampicillin, piperacillin, tetracycline, and ciprofloxacin, and for S. saprophyticus they were: amoxicillin/clavulanic acid, trimethoprim / sulfamethoxazole, ceftriaxone and ciprofloxacin(AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Infecções Urinárias/tratamento farmacológico , Farmacorresistência Bacteriana , Escherichia coli/efeitos dos fármacos , Staphylococcus saprophyticus/efeitos dos fármacos , Peru/epidemiologia , Resistência Microbiana a Medicamentos/imunologia , Prontuários Médicos , Estudos Transversais , Hospitais Públicos , Klebsiella pneumoniae/efeitos dos fármacos , Anti-Infecciosos Urinários/uso terapêutico
19.
Int Urol Nephrol ; 53(11): 2267-2272, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34499326

RESUMO

PURPOSE: To assess the efficacy of prophylaxis for urinary tract infections (UTI) in a two-year follow-up in women with StroVac compared to a therapy with Nitrofurantoin over three months. MATERIALS AND METHODS: All patients with documented recurrent urinary tract infections (rUTI) were offered vaccination with StroVac or therapy with three months Nitrofurantoin 100 mg once daily for three months at patient's choice. Only patients with a follow-up of at least 24 months were included. All episodes with signs of UTI were documented and urine culture was performed. Success was defined as one or none UTI per 12 months, documented by urine culture. StroVac booster injection was offered 12 months after primary vaccination at patient's choice. RESULTS: 173 patients were included in this study, 124 in the StroVac group, 49 chose Nitrofuratoin. In the first 12 months, 86.8% of patients in the StroVac group and 91.8% in Nitrofurantoin group were successful (p = 0.22). Side effects were noted in 2.3% in the StroVac group causing discontinuation of therapy, whereas in the Nitrofurantoin group 18.4% stopped medication premature, mostly due to mild diarrhoea. In the second year 79.3% of patients in the StroVac group were still successful, most of them had undergone booster injection. In contrast, in the Nitrofurantoin group only 59.2% of patients were still successful (p = 0.03). CONCLUSION: StroVac is an effective and lasting non-antibiotic prophylaxis for rUTI, easy to administer with low rates of adverse events and should be offered to patients with rUTI.


Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Vacinas Bacterianas/uso terapêutico , Nitrofurantoína/uso terapêutico , Infecções Urinárias/prevenção & controle , Adulto , Idoso , Vacinas Bacterianas/imunologia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva
20.
J Laryngol Otol ; 135(10): 855-857, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34477050

RESUMO

OBJECTIVE: Recurrent acute otitis media is common in children. The preferred treatment measures for recurrent acute otitis media have a mixed evidence base. This study sought to assess baseline practice across ENT departments in England. METHODS: A national telephone survey of healthcare staff was conducted. Every ENT centre in England was contacted. A telephone script was used to ask about antibiotic and grommet use and duration in recurrent acute otitis media cases. RESULTS: Ninety-six centres (74 per cent) provided complete information. Recurrent acute otitis media treatment across England by ENT departments varied. The antibiotic first- and second-line prophylaxis offered varies, with trimethoprim used in 33 centres and 29 centres not offering any antibiotics. The timing or choice about when to use grommets also varies, but 87 centres (91 per cent) offer grommet surgery at one stage. CONCLUSION: The treatments received by children in England for recurrent acute otitis media vary by centre; collaborative research in this area is advised.


Assuntos
Ventilação da Orelha Média/estatística & dados numéricos , Otite Média/tratamento farmacológico , Otolaringologia/estatística & dados numéricos , Inquéritos e Questionários/normas , Doença Aguda , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anti-Infecciosos Urinários/administração & dosagem , Anti-Infecciosos Urinários/uso terapêutico , Criança , Resistência Microbiana a Medicamentos , Inglaterra/epidemiologia , Humanos , Ventilação da Orelha Média/métodos , Otite Média/cirurgia , Otolaringologia/organização & administração , Assistência Individualizada de Saúde/estatística & dados numéricos , Recidiva , Medicina Estatal/organização & administração , Inquéritos e Questionários/estatística & dados numéricos , Trimetoprima/administração & dosagem , Trimetoprima/uso terapêutico
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