ABSTRACT
Antecedentes: Descripción de la condición de salud de interés (indicación): La Neumonía Adquirida en la Comunidad (NAC), e s una enfermedad resultante de la inflamación del parénquima pulmonar generada por un agente infeccioso fuera del ambiente hospitalario. El cuadro clínico se caracteriza por tos, fiebre y signos de consolidación al examen físico, pero puede ser muy variable y mostrar otros síntomas locales como disnea, dolor torácico, expectoración, taquipnea, o generales como fiebre, escalofríos confusión y taquicardia. Información de la tecnología: La cefuroxima es muy activa frente a la mayoría de las bacterias gram-positivas (incluyendo las cepas productoras de penicilinasa) como los estafilococos (S. aureus, S. epidermis), estreptococos (a excepción de los enterococos) y algunas bacterias gram-positivas anaerobias. Entre las bacterias gram-negativas sensibles a la cefuroxima se encuentran los E.coli, Klebsiella, H.influenzae, Proteus mirabilis, N.meningitidis, y N.gonorrhoeae, incluyendo las cepas que son productoras de beta-lactamasas. Otros gérmenes sensibles son la Pasteurella multocida, Citrobacter, Salmonella, Shigella, y Yersinia. La cefuroxima tiene poca actividad frente a especies de Providencia, P. vulgaris, Serratia, o Pseudomonas. Tampoco es efectiva frente a la Listeria meningitis. Evaluación de efectividad y seguridad: ¿Cuál es la efectividad y seguridad de cefaclor, cefprozil y cefuroxima comparados con amoxicilina, amoxicilina/ácido clavulánico, eritromicina, claritromicina o azitromicina, como monoterapia ambulatoria de primera línea para NAC no complicada en niños menores de 5 años? La pregunta de evaluación fue refinada y validada con base en: autorización de mercadeo de las tecnologías para la indicación de interés (registro sanitario INVIMA), listado de medic\r\namentos vitales no disponibles, cobertura de las tecnologías en el Plan Obligatorio de Salud (POS) \r\n(Acuerdo 029 de 2011), revisión de grupos terapéuticos (clasificación ATC: Anatomical, Therapeutic, Chemical classification system), recomendaciones de guías de práctica clínica actualizadas, disponibilidad de evidencia sobre efectividad y seguridad (reportes de evaluación de tecnologías y revisiones sistemáticas de la literatura), uso de las tecnologías (listas nacionales de recobro, estadísticas de prescripc\r\nión, etc), estudios de carga de enfermedad. Población: Personas con diagnóstico de Neumonía Adquirida en la comunidad. Tecnología de interés: Amoxicilina, amoxicilina/ácido clavulánico, eritromicina, claritromicina o azitromicina. Metodología: Búsqueda de literatura, Búsqueda en bases de datos electrónica.Conclusiones: No existen diferencias estadísticamente significativas en cuanto a efectividad al comparar tasas de curación de cefuroxima con amoxicilina. No existen diferencias estadísticamente significativas en cuanto a efectividad al comparar tasas de curación de cefuroxima con claritromicina. No se encontraron comparaciones entre cefaclor, cefprozil con amoxicilina, amoxicilina/ácido, clavulánico, eritromicina, claritromicina y azitromicina. La revisión sistemática es de alta calidad, pero hacen falta estudios que permitan aclarar las diferencias entre cefuroxima y amoxicilina/ácido clavulánico, eritromicina, y azitromicina.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Pneumonia/drug therapy , Technology Assessment, Biomedical , Cefaclor/administration & dosage , Cefuroxime/administration & dosage , Cephalosporins/administration & dosage , Treatment Outcome , Colombia , Community-Acquired InfectionsABSTRACT
Dental materials with antibacterial properties can prevent the harmful effects caused by oral cariogenic bacteria. This double-blind controlled clinical trial evaluated the performance of a glass ionomer cement (GIC) added with antibiotics for sealing infected dentin in atraumatic restorations of primary molars. The study enrolled 45 children (45 teeth) between 5 and 8 years of age, of both genders, divided into two groups: GC (n=22), where cavities were lined with a conventional GIC (Vidrion F) and GA (n=23), with cavities lined with Vidrion F added with 1% each of metronidazole, ciprofloxacin and cefaclor antibiotic. Both groups were restored with Ketac Molar Easymix. Molars with carious lesions on the inner half of dentin without clinical or radiographic pulp damage were selected. Patients were evaluated clinically (pain, fistulas or mobility) and radiographically (area of caries, periapical region and furcation) after 1, 3, 6 and 12 months. For statistical analysis, chi-squared or Fisher's exact tests were used with a 5% significance level. GA (82.6-95.7%) had better results than GC (12.5-36.4%) in all evaluations (p<0.05) and the difference in the success rate was 46.2-72.5% higher for GA. The use of the antibiotic-containing GIC liner on infected dentin proved satisfactory when applied in deciduous teeth.
Os materiais dentários com propriedades antibacterianas podem proteger os efeitos nocivos causados por bactérias cariogênicas. Este ensaio clínico controlado duplo-cego avaliou o desempenho do cimento de ionômero de vidro (CIV) associado à antibióticos no selamento da dentina infectada em restaurações atraumáticas de molares decíduos. O estudo envolveu 45 crianças (45 dentes) entre 5 e 8 anos de idade, de ambos os sexos, divididos em dois grupos: GC (n=22), onde as cavidades foram forradas com CIV convencional (Vidrion F) e GA (n=23), onde as cavidades foram forradas com Vidrion F contendo 1% de cada um dos antibióticos metronidazole, ciprofloxacina e cefaclor. Ambos os grupos foram restaurados com Ketac Molar Easymix. Molares com lesões de cárie na metade interna da dentina, sem danos pulpares clínicos ou radiográficos foram selecionados. Os pacientes foram avaliados clinicamente (presença de dor, fístulas ou mobilidade) e radiograficamente (área de cárie, região periapical e de furca dos dentes), após 1, 3, 6 e 12 meses. Para a análise estatística o Qui-quadrado ou Exato de Fisher foram utilizados com 5,0% de significância. GA (82,6-95,7%) obteve melhores resultados do que GC (12,5-36,4%) em todas as avaliações (p<0,05) e a diferença na taxa de sucesso foi de 46,2-72,5% maior para GA. O uso do CIV com antibióticos no forramento da dentina infectada foi satisfatório em dentes decíduos.
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Anti-Bacterial Agents/administration & dosage , Cariostatic Agents/chemistry , Dental Cavity Lining , Dental Atraumatic Restorative Treatment/methods , Dental Caries/therapy , Dentin/pathology , Glass Ionomer Cements/therapeutic use , Chi-Square Distribution , Cariostatic Agents/therapeutic use , Cefaclor/administration & dosage , Ciprofloxacin/administration & dosage , Double-Blind Method , Dentin/microbiology , Glass Ionomer Cements/chemistry , Metronidazole/administration & dosage , Tooth, DeciduousABSTRACT
The effect of temperature stresses on Cefaclor suspensions under different storage conditions for a duration of 14 days was tested. The degradation of Cefaclor was determined on the 2[nd], 7[th] and 14[th] day after reconstitution using a sensitive and precise Reversed phase High Performance Liquid Chromatographic [RP-HPLC] method. The RSD values for Forticef, Midocef, Ceclor, Cefabac and Cloracef, indicated a good precision of the RP-HPLC method. The limit of detection [LOD] and the limit of quantification [LOQ] were found 0.008 mg/ml and 0.03mg/ml respectively. The antimicrobial effect of Cefaclor suspension was also tested against pathogenic bacteria using the cylinder diffusion method. The RSD values range of the antimicrobial assay for all the Cefaclor compounds were 1.47-3.7%. The LOD and LOQ were 0.2mg/ml and Img/ml respectively. During the normal use of Ceclor, Midocef, and Forticef the loss of activity and the degradation were less than 5% on the 14[th] day of preservation at 4°C. However, the percentage of degradation for Cefabac and Cloracef on the 14th day reached 5 and 6%, respectively. Statistical multiple comparison between the effect of 4°C and 25°C indicated non significant mean differences [P >/= 0.05] for Forticef, Cefabac, Ceclor and Cloraf and significant effect for Midocef [P
Subject(s)
Humans , Cefaclor/pharmacology , Cefaclor/administration & dosage , Chromatography, Reverse-Phase/methods , Disk Diffusion Antimicrobial Tests/methods , Drug Stability , Administration, Oral , Suspensions , Temperature , Time Factors , Anti-Bacterial Agents/chemistry , Anti-Bacterial Agents/pharmacology , Drug Storage/statistics & numerical dataABSTRACT
Acute Otitis Media (AOM) is the most frequent respiratory tract infection of infancy and childhood that is treated with antimicrobial agents. The most common causative pathogens include Streptococcus pneumoniae, Hemophilus influenzae and Moxarella catarrhalis, and therefore antibacterial management should target against these isolates. Cefaclor, a congener of cephalexin monohydrate, is a semisynthetic cephalosporin antibiotic. It is an orally active cephalosporin which has demonstrated activity against a wide range of organisms in vitro. Present study is designed as a multicentric prospective trial to study and compare the efficacy and safety of cefaclor versus amoxicillin + clav in children with acute otitis media. One hundred and sixty seven patients were evaluated for efficacy endpoints in the cefaclor arm comprised of 104 males and 63 females with a mean age of 5.74+/-2.80 years and 185 patients in the amoxy-clav group comprised of 118 males and 67 females with a mean age of 4.93+/-2.92 years. Both cefaclor and amoxy-clav caused a significant improvement in all the signs and symptoms after a 10-day treatment period. However, between-the-group comparisons showed that the reduction in most of the symptoms was significantly more in cefaclor arm as compared to amoxicillin-clav arm. The clinical success (clinical cure + improvement) at the end of therapy was significantly more in cefaclor arm: 98% with cefaclor versus 85% with amoxicillin + clav, p<0.05 Table 3. Failure cases were prescribed other antibiotics according to the culture sensitivity reports, as rescue medication. Bacterial eradication rates were largely consistent with clinical responses. Bacteriological eradication was seen in 95% of patients in cefaclor group and 78% of patients in amoxicillin + clav group. In conclusion, cefaclor is a well tolerated and effective antibacterial option for acute otitis media in children and it is superior to the combination of amoxicillin + clav in efficacy and tolerability in acute AOM. Moreover, its expanded spectrum of activity, ability to achieve adequate concentrations in tissues, suitability for twice-daily dosing, and proven tolerability suggest that it is a good alternative to agents traditionally used in acute otitis media.
Subject(s)
Acute Disease/therapy , Amoxicillin-Potassium Clavulanate Combination/administration & dosage , Anti-Bacterial Agents/administration & dosage , Cefaclor/administration & dosage , Child , Child, Preschool , Female , Haemophilus influenzae/isolation & purification , Humans , Infant , Male , Moraxella catarrhalis/isolation & purification , Otitis Media/drug therapy , Prospective Studies , Streptococcus pneumoniae/isolation & purification , Treatment OutcomeABSTRACT
Thirty patients with acute urinary tract infection were treated orally with 500 mg of cefaclor three times a day for 7 days. Urine cultures were made before treatment and after therapy. In 97 per cent (29/30) of these patients clinical success was achieved and in 90 per cent (27/30) of them, pathogens were eradicated. Our study showed that cefaclor was still active against most Enterobacteriaceae, such as Escherichia coli and Klebsiella species, the principle pathogens of urinary tract infection. No adverse effects of cefaclor were observed in this study.
Subject(s)
Administration, Oral , Adolescent , Adult , Cefaclor/administration & dosage , Cephalosporins/administration & dosage , Cystitis/drug therapy , Enterobacteriaceae/isolation & purification , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Cefetamet Pivoxil, uma cefaloscoporina oral de terceira geraçao, foi investigada em um estudo aberto e randomizado, em 130 crianças portadoras de OMA. A eficácia e tolerabilidade de 20 mg/Kg de Cefetamet xarope, em duas doses diárias, em 68 pacientes foi comparada com 40 mg/Kg de Cefaclor, em três doses diárias, em 62 pacientes, ambas administradas por via oral por sete dias. Após este período obteve-se 95,6 por cento de cura com Cefetamet e 85,5 por cento com Cefaclor, insucesso no tratamento ocorreu em 4,4 por cento com Cefetamet 11,3 por cento com Cefaclor. Dois pacientes tratados com Cefaclor foram considerados nao avaliáveis, um por abandono e outro por suspensao do tratamento por efeitos colaterais gastrointestinais.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Cefaclor/therapeutic use , Cephalosporins/therapeutic use , Otitis Media/drug therapy , Acute Disease , Cefaclor/administration & dosage , Cephalosporins/administration & dosage , Drug Tolerance , Treatment OutcomeABSTRACT
Introducción.La elevada incidencia de infección urinaria(I.U)en pediatría,junto al aumento de la resistencia de las cepas de Escherichia coli en nuestro medio,determina la necesidad de buscar nuevas opciones terapeúticas.Para ello se comparado la efectividad y tolerancia de ceflacor(CCL)vs cefradroxilo(CDX)para el tratamiento de la I.U en pacientes pediátricos.Material y Métodos.Se trataron 60 pacientes de ambos sexos,con edades comprendidas entre 7 y 156 meses portadores de I.U.Se realizó un estudio multicéntrico comparativo,al azar,en el que se utilizó CDX a 30 mg/kg/día,ambos cada 12 horas por vía oral.La duración del tratamiento fue de 3 y 10 días para infección urinaria baja(I.U.B) e infección urinaria alta,respectivamente,de acuerdo a los criterios de localización utilizados.Conclusiones.Ambos antimicrobianos demostraron ser efectivos para el tratamiento de la I.U presentando los dos muy buena tolerancia oral.CCL presentó mejor actividad frente a las cepas de E.coli aisladas,por lo que consideramos que es una alternativa efectiva para el tratamiento de la IU en pediatría
Subject(s)
Infant , Child, Preschool , Cefaclor/administration & dosage , Cefaclor/therapeutic use , Escherichia coli/drug effects , Escherichia coli/immunology , Urinary Tract Infections/therapy , PediatricsABSTRACT
A acetil cefuroxima foi comparada ao cefaclor no tratamento de infecçöes das vias respiratórias inferiores. Sessenta e um paciente foram distribuídos aleatoriamente em três grupos e se submeteram aos seguintes esquemas pososlógicos: (1) axetil cefuroxima, 250 mg por via oral cada 12 horas (21 pacientes); (2) axetil cefuroxima, 500 mg por via oral cada 12 horas (21 pacientes); 3 (3) cefaclor, 500 mg por via oral cada oito horas (19 pacientes). Desses 61 pacientes, 80 por cento eram homens, com idade média de 59,5 anos; 56 por cento apresentavam pneumonia aguda enquanto o restante tinha bronquite aguda. Os patógenos causais incluíram patógenos típicos do trato respiratório. Em suma 23 de 27 pacientes com bronquite estavam clinicamente curados ao se concluído o tratamento. Trinta e um dos 34 casos de pneumonia foram clinicamente curados ou melhoraram ao término da terapia; as três falhas terapêuticas em pacientes com pneumonia ocorreram nos grupos tratados com a menor dose cefuroxima (n=2) e de cefaclor (n=1). De modo geral, houve cura bacteriológica em 86 por cento dos pacientes tratados com 500mg de axetil cefuroxima em comparaçäo com 60 por cento dos pacientes que receberam tratamento com cefaclor. Os efeitos adversos foram raros. Baseando-se neste estudo, concluiu-se que a axetil cefuroxima, administrada cada 12 horas, é pelo menos, täo eficaz quanto o cefaclor em termos clínicos; trata-se de uma nova cefalosporina oral que, em comparaçäo com muitos outros agentes mais antigos, apresenta vantagens farmacológicas e de espectro antibacteriano
Subject(s)
Humans , Adolescent , Bronchitis/diagnosis , Cefaclor/administration & dosage , Cefuroxime/administration & dosage , Pneumonia/diagnosis , Brazil , Drug Evaluation , Outpatients , Drug Resistance, MicrobialABSTRACT
Se presenta en este estudio la evaluación clínica y bacteriológica del tratamiento oral con cefaclor de las dermatosis bacterianas severas en Pediatría. Se trataron infecciones graves o extendidas y asociadas a enfermedades y/o tratamientos inmunosupresores. Se incluyeron un total de 32 pacientes, 17 de los cuales presentaban inmunodeficiencias ya sea por tratamiento con corticoesteroides sistémicos (5) o por enfermedades concomitantes, como leucemia (2), enfermedad de Hodgkin (3), síndrome de Buckley (2) y varicela (5). Los 15 pacientes restantes presentaron enfermedades dermatológicas severas como síndrome estafilocóccico de la piel escaldada (SEPE) (6), celulitis (7) y piodermitis diseminada (2). La etiología bacteriana más frecuente fue Staphylococcus aureus (S.a.), que se aisló en 21 pacientes (66 por ciento), seguida por la asociación S. a. con Streptococcus Beta Hemolítico Grupo A (SBHA) en 8 pacientes (25 por ciento). El tratamiento instituido con 40 mg/kg/día de cefaclor repartidos en dos tomas durante 7-14 días (según evolución) resultó efectivo, obteniéndose mejoría clínica a las 48-96 hs. en ambos grupos de pacientes. Uno solo de los pacientes inmunosuprimidos presentó falla terapéutica y ninguno de los restantes tuvieron recaídas dentro de los 28 días