Structural elucidation, mechanism of action, antibacterial proficiency and synergistic forte of purified Euphorbia hirta whole plant extract against multi-drug resistant otitis media infection / Elucidación estructural, mecanismo de acción, competencia antibacteriana y fuerza sinérgica del extracto de planta entera de Euphorbia hirta purificado contra la infección por otitis media resistente a múltiples fármacos

This study investigated the antibacterial potential of Euphorbia hirtawhole plant extracts, honey and conventional antibiotics and their synergistic effects against selected multidrug resistant and typed bacterial strains associated with otitis media. E. hirtawhole plant extract was purified using column chromatography technique. The antibacterial assays of extracts were done using standard microbiological procedures. Protein, sodium and potassium ion leakage of the synergistic mixtures was determined using flame-photometry. At 100 mg/ml, acetone extracts presented highest inhibition against S. aureus (NCTC 6571) with 32 ± 0.83 mm zone of inhibition. The fractional inhibitory concentration indices displayed higher synergism in combination of plant extract, honey and ciprofloxacin against P. mirabilisat 0.02 compared to drug combination synergy standard (≤ 0.5). This work revealed augmentation of ciprofloxacin potency when combined with purified E. hirta acetone extract and honey and implies their high potential in the treatment of multidrug resistant infectionof otitis media.

Este estudio investigó el potencial antibacteriano de extractos de plantas enteras de Euphorbia hirta, miel y antibióticos convencionales y sus efectos sinérgicos contra cepas bacterianas seleccionadas multirresistentes y tipificadas asociadas con la otitis media. El extracto de la planta entera de E. hirtase purificó usando la técnica de cromatografía en columna. Los ensayos antibacterianos de extractos se realizaron utilizando procedimientos microbiológicos estándar. La fuga de iones de proteínas, sodio y potasio de las mezclas sinérgicas se determinó mediante fotometría de llama. A 100 mg/ml, los extractos de acetona presentaron la mayor inhibición contra S. aureus (NCTC 6571) con una zona de inhibición de 32 ± 0,83 mm. Los índices de concentración inhibitoria fraccional mostraron un mayor sinergismo en combinación de extracto de planta, miel y ciprofloxacina contra P. mirabilisa 0,02 en comparación con el estándar de sinergia de combinación de fármacos (≤ 0,5). Este trabajo reveló un aumento de la potencia de la ciprofloxacina cuando se combina con extracto de acetona purificado de E. hirtay miel e implica sualto potencial en el tratamiento de infecciones de otitis media resistentes a múltiples fármacos.

What is the effectiveness of beta-glucan for treatment of acute otitis media? / Qual é a eficácia do beta-glucano no tratamento da otite média aguda?

Abstract Introduction: As a supplement, beta-glucan has various therapeutic healing effects generated by the immune cells. It has been scientifically approved and proven to be a biological defense modifier. The aim of this study was to investigate the effects of beta-glucan on treatments administered in an acute otitis media model Objectives: This study investigated the effect of beta-glucan on the treatment of acute otitis media in an acute otitis media -induced animal model. Efficacy was evaluated both immunologically and histologically. Methods: The study sample comprised 35 adult rats, randomly separated into 5 groups of 7: Group 1 (control), Group 2 (acute otitis media, no treatment), Group 3 (acute otitis media + antibiotic), Group 4 (acute otitis media + beta-glucan) and Group 5 (acute otitis media + beta-glucan + antibiotic). Analyses were made of the histopathology and immunology examination results in respect of thickening of the tympanic membrane, epithelium damage, inflammation, and sclerosis. In all groups the serum levels of TNF-α, IL-4, IL-6 and IL-1β were evaluated. Results: All serum cytokine levels were significantly lower in the beta-glucan and antibiotictreated groups compared to the acute otitis media Group. Significant differences in tympanic membrane thickness, inflammation, epithelium damage, and sclerosis values were observed between the acute otitis media + antibiotic and acute otitis media + beta-glucan Groups. According to these parameters, the values in aute otitis media + antibiotic + beta-glucan Group were markedly lower than those of the other groups. There was a significant difference in the acute otitis media + antibiotic + beta-glucan Groups compared to acute otitis media Group (p < 0.001). Conclusions: Both antibiotic and beta-glucan treatment reduced acute otitis media signs of inflammations in an acute otitis media-induced rat model, decreasing histological damage and cytokine levels. Co-administration of antibiotic and beta-glucan led to a significant reduction in tympanic membrane thickness, inflammation, and epithelium damage. Antibiotic + beta-glucan treatment resulted in a greater decrease in tympanic membrane thickness, inflammation, and epithelium damage than in the other groups. From these results, it can be suggested that beta-glucan, in combination with antibiotics may provide an alternative for the treatment of acute otitis media.

Resumo Introdução: Como suplemento, o beta-glucano apresenta vários efeitos terapêuticos gerados pelas células imunológicas. Cientificamente aprovado, mostrou ser um modificador de defesa biológica. Objetivo: Investigar os efeitos do beta-glucano nos tratamentos administrados em um modelo de otite média aguda induzida em um modeloanimal. A eficácia foi avaliada imunológica e histologicamente. Método: A amostra do estudo foi composta por 35 ratos adultos, divididos aleatoriamente em 5 grupos de 7: grupo 1 (controle), grupo 2 (otite média aguda, sem tratamento), grupo 3 (otite média aguda + antibiótico), grupo 4 (otite média aguda + beta-glucano) e grupo 5 (otite média aguda + beta-glucano + antibiótico). Foram feitas análises dos resultados dos exames histopatológicos e imunológicos em relação ao espessamento da membrana timpânica, dano ao epitélio, inflamação e esclerose. Os níveis séricos de TNF-α, IL-4, IL-6 e IL-β foram avaliados em todos os grupos. Resultados: Todos os níveis séricos de citocinas foram significativamente mais baixos nos grupos tratados com beta-glucano e antibióticos em comparação com o grupo otite média aguda. Diferenças significativas na espessura da membrana timpânica, inflamação, dano do epitélio e esclerose foram observadas entre os grupos otite média aguda + antibiótico e otite média aguda + beta-glucano. De acordo com esses parâmetros, os valores no grupo otite média aguda + antibiótico + beta-glucano foram acentuadamente inferiores aos dos demais grupos. Houve uma diferença significante no grupo otite média aguda + antibiótico + beta-glucano em comparação ao grupo otite média aguda (p < 0,001). Conclusão: Ambos os tratamentos com antibiótico e com beta-glucano reduziram os sinais de inflamação da otite média aguda em um modelo de rato com otite média aguda induzida, diminuíram os danos histológicos e os níveis de citocinas. A administração concomitante de antibiótico e beta-glucano levou a uma redução significativa na espessura da membrana timpânica, inflamação e danos ao epitélio. O tratamento com antibióticos + beta-glucano resultou em maior diminuição na espessura da membrana timpânica, inflamação e danos no epitélio do que nos outros grupos. A partir desses resultados, pode-se sugerir que o beta-glucano, em combinação com antibióticos, pode fornecer uma opção para o tratamento da otite média aguda.

Enfrentamiento práctico a patologías otorrinolaringológicas frecuentes durante el embarazo, una revisión de la literatura / Treatment of frequent otorhinolaryngological pathologies during pregnancy, a review of the literature

RESUMEN Durante el embarazo ocurren una serie de cambios, como edema y disminución de la actividad ciliar en la mucosa respiratoria alta, que pueden favorecer la aparición de síntomas y patologías del área otorrinolaringológica. La eficacia de los tratamientos farmacológicos en la rinitis del embarazo es pobre. El tratamiento de primera línea de la rinitis alérgica son los corticoides intranasales. Existe evidencia sobre la seguridad en el embarazo para furoato de fluticasona, mometasona y budesonida intranasal. El tratamiento del resfrio común está enfocado en el manejo sintomático, los antinflamatorios no esteroidales están contraindicados. En rinosinusitis aguda bacteriana la amoxicilina es de primera línea. En rinosinusitis crónica el manejo quirúrgico está reservado sólo para las complicaciones. Tanto la otitis media aguda como la amigdalitis aguda deben ser tratadas con antibióticos sólo si se sospecha origen bacteriano, el esquema de primera linea es amoxicilina y en caso de alergias se debe usar cefpodoxime o azitromicina. En caso de otorrea no existe evidencia sobre la seguridad de las gotas de antibióticos ótico durante el embarazo. Múltiples medicamentos utilizados habitualmente en otorrinolaringologia no pueden ser usados durante el embarazo. Se debe privilegiar la seguridad materno fetal, utilizando aquellos medicamentos con seguridad demostrada.

ABSTRACT During pregnancy a series of changes occur, such as edema and decreased ciliary activity in the upper respiratory mucosa, which may favor the appearance of symptoms and pathologies of the otorhinolaryngological area. The efficacy of pharmacological treatments in rhinitis of pregnancy is poor. The first-line treatment of allergic rhinitis is intranasal corticosteroids. There is evidence on safety in pregnancy for fluticasone furoate, mometasone and intranasal budesonide. The treatment of the common cold is focused on symptomatic management, nonsteroidal anti-inflammatory drugs are contraindicated. In acute bacterial rhinosinusitis, amoxicillin is first-line. In chronic rhino-sinusitis in surgical management is reserved only for complications. Both acute otitis media and acute tonsillitis should be treated with antibiotics only if bacterial origin is suspected, the first-line treatment is amoxicillin, in the case of allergies, cefpodoxime or azithromycin should be used. In case of otorrhea there is no evidence on the safety of otic antibiotic drops during pregnancy. Conclusion: multiple medications commonly used in otorhinolaryngology cannot be used during pregnancy. Maternal and fetal safety should be privileged, using those medications with proven safety.

Aspectos clínicos y bacteriológicos de las mastoiditis agudas como complicación de otitis media aguda y crónica en pediatría, Experiencia en 10 años / Clinical and bacteriological features of acute mastoiditis as a complication of acute and chronic otitis media in pediatrics. A 10-years experience

Antecedentes. Cualquier paciente pediátrico o adulto que presente otitis media aguda (OMA) u otitis media crónica (OMC), particularmente colesteatomatosa, puede desarrollar complicaciones intratemporales y endocraneales, especialmente mastoiditis aguda (MA). Objetivo. Describir las características clínicas y bacteriología de los pacientes asistidos por MA como complicación de OMA y OMC. Lugar de aplicación: Servicio de Otorrinolaringología. Hospital de Pediatría Juan P. Garrahan. Diseño. Descriptivo, retrospectivo, transversal y observacional. Población. Pacientes con mastoiditis aguda por OMA y por OMC asistidos en el Servicio de ORL durante 10 años. Material y métodos. Revisión de historias clínicas de todos los pacientes tratados entre enero de 1999 y diciembre de 2008. Resultados. Se estudiaron 57 pacientes con MA, 40/57 por OMA y 17/57 por OMC. Hubo 40 niños hospitalizados con signos y síntomas de MA por OMA. Se diagnosticó complicación endocraneal en el 12,5% (5/40) de los casos. Los aislamientos bacterianos más frecuentes fueron Streptococcus pyogenes, Streptococcus pneumoniae, H. influenzae y Turicella otitidis. Se registraron 17 casos de niños hospitalizados con diagnóstico de MA y OMC. Ocurrieron complicaciones supurativas intracraneales en el 35,3% (6/17) de los casos. Los aislamientos bacterianos más frecuentes fueron las enterobacterias, P. aeruginosa y los gérmenes anaerobios. Conclusión. El diagnóstico de tipo y estadio de otitis media previa o coexistente a la complicación es fundamental para encarar el tratamiento antimicrobiano empírico inicial, sospechar complicaciones endocraneales asociadas y proponer procedimientos quirúrgicos menores, medianos o mayores oportunamente (AU)

Background. Any pediatric or adult patient presenting with acute otitis media (AOM) or chronic otitis media (COM), especially cholesteatomatous, may develop intratemporal and intracranial complications, mainly acute mastoiditis (AM). Objective. To describe the clinical and bacteriological features of patients seen for AM as a complication of AOM and COM. Setting: Department of Otolaryngology, Hospital de Pediatría Juan P. Garrahan. Design. A descriptive, retrospective, cross-sectional, observational study. Population. Patients with AM because of AOM and COM seen at the Department of Otolaryngology over a 10-year period. Material and methods. Review of the clinical charts of all patients treated between January 1999 and December 2008. Results. 57 Patients with AM, 40/57 due to AOM and 17/57 due to COM, were evaluated. Forty children were admitted to hospital with signs and symptoms of AOM-related AM. Intracranial complications were observed in 12.5% (5/40) of the patients. The most frequently isolated pathogens were Streptococcus pyogenes, Streptococcus pneumoniae, H. influenzae, and Turicella Otitidis. Seventeen children were hospitalized because of COM-related AM. Suppurative intracranial complications occurred in 35.3% (6/17) of the cases. The most frequently isolated pathogens were Enterobacteriaceae, P. aeruginosa, and anaerobic bacteria. Conclusion. The diagnosis of type and stage of otitis media prior to or coexisting with the complication is essential to address the initial empirical antimicrobial treatment, associated intracranial complications should be suspected and minor, intermediate, or major surgical procedures should be proposed at the appropriate time (AU)

How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel / Como evitar o uso inadequado de antibióticos nas infecções de vias aéreas superiores? Posição de um painel de especialistas

Abstract Introduction: Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. Objectives: To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. Methods: A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. Results: Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into 'consideration'. Conclusions: Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use.

Resumo Introdução: A resistência bacteriana a antibióticos nos processos infecciosos é um fato crescente nos últimos anos, especialmente devido ao seu uso inapropriado. Ao longo dos anos vem se tornando um grave problema de saúde pública devido ao prolongamento do tempo de internação, elevação dos custos de tratamento e aumento da mortalidade relacionada às doenças infecciosas. Quase a metade das prescrições de antibióticos em unidades de pronto atendimento é destinada ao tratamento de alguma infecção de vias aéreas superiores, especialmente rinossinusites, otite média aguda supurada e faringotonsilites agudas, sendo que uma significativa parcela dessas prescrições é inapropriada. Nesse contexto, os otorrinolaringologistas têm um papel fundamental na orientação de pacientes e colegas não especialistas, para o uso adequado e racional de antibióticos frente a essas situações clínicas. Objetivos: Realizar uma revisão das atuais recomendações de utilização de antibióticos nas otites médias, rinossinusites e faringotonsilites agudas adaptadas à realidade nacional. Método: Revisão na base PubMed das principais recomendações internacionais de tratamentos das infecções de vias aéreas superiores, seguido de discussão com um painel de especialistas. Resultados: Os antibióticos devem ser utilizados de maneira criteriosa nas infecções agudas de vias aéreas superiores não complicadas, a depender da gravidade da apresentação clínica e dos potenciais riscos associados de complicações supurativas e não supurativas. Conclusões: Constantes revisões a respeito do tratamento das principais infecções agudas são necessárias para que sejam tomadas medidas coletivas no uso racional e apropriado de antibióticos. Somente com orientação e transformações no comportamento de médicos e pacientes é que haverá mudanças do paradigma de que toda infecção de vias aéreas superiores deva ser tratada com antibióticos, minimizando por consequência os efeitos de seu uso inadequado.

Uso de probióticos en otorrinolaringología / Use of probiotics in otolaryngology

En los humanos las infecciones más frecuentes son las respiratorias, siendo la principal indicación de antibióticos en niños. El uso indiscriminado de antibióticos lleva a la aparición de gérmenes multirresistentes. Uno de los objetivos actuales en salud es la prevención de las enfermedades infecciosas para disminuir el uso de antibióticos. Una estrategia postulada recientemente para prevenir infecciones respiratorias es el uso de probióticos.

In humans, the most frequent infections are respiratory, being the main indication of antibiotics in children. The indiscriminate use of antibiotics leads to the emergence of multi-resistant germs. One of the current health objectives is the prevention of infectious diseases so we can reduce the use of antibiotics. A potential strategy for preventing respiratory infections is the use of probiotics.

Adherence to acute otitis media treatment guidelines among primary health care providers in Israel

AIMS: To determine the appropriateness of the acute otitis media antibiotic treatment prescribed in the community in relation to the therapeutic guidelines. METHODS: Children aged 3 months-3 years diagnosed with simple uncomplicated acute otitis media in 6 community primary care clinics were enrolled. Data on the antibiotic treatment were collected using computerized medical files. RESULTS: 689 simple uncomplicated acute otitis media patients were enrolled; 597 (86.9%) were treated with antibiotics by 38 family medicine practitioners, 12 pediatricians and 7 general practitioners. 461 (77.2%) patients were <2 years of age. Amoxicillin was administered to 540 (90.5%) patients, with no differences between the various medical specialties. 127/540 (23.5%) patients did not receive the appropriate dosage; 140/413 (33.9%) patients treated with appropriate dosage did not receive the treatment for the appropriate duration of time. 258/357 (72.3%) evaluable patients <2 years of age received an antibiotic considered inappropriate to guidelines (38 not treated with amoxicillin, 94 received inappropriate dosage and 126 not treated for 10 days); 53/100 (53%) evaluable children >2 years of age received an inappropriate antibiotic treatment. CONCLUSIONS: The majority of primary care physicians treat simple uncomplicated acute otitis media with the recommended antibiotic drug. However, incorrect dosage and shorter than recommended duration of therapy may jeopardize the quality of care in children with simple uncomplicated acute otitis media. .

Consenso sobre diagnóstico y tratamiento de infecciones de vías respiratorias altas / Consensus guidelines for the management of upper respiratory tract infections

Las infecciones respiratorias altas son la primera causa de prescripción de antibióticos. La faringitis aguda es de origen viral en la mayoría de los casos; los episodios virales pueden diferenciarse de los de origen bacteriano producidos por Streptococcus pyogenes por criterios clínico-epidemiológicos (criterios de Centor), por pruebas diagnósticas rápidas o por el cultivo de fauces. Cuando la etiología es estreptocócica, la droga de elección es penicilina V (cada 12 horas). La otitis media aguda (OMA) es una de las causas más frecuentes de prescripción de antibióticos en niños. Los patógenos principales son Streptococcus pneumoniae, Haemophilus influenzae no tipable y Moraxella catarrhalis. Los antecedentes, la evaluación clínica junto con la otoscopía permiten establecer el diagnóstico. En niños menores de 2 años se recomienda tratamiento antibiótico precoz al igual que en niños mayores de 2 años con otitis bilateral, otorrea, presencia de comorbilidad o cuadro clínico grave. En la Argentina, debido a los bajos niveles de resistencia de S. pneumoniae a penicilina la droga de elección es amoxicilina; ante falta de respuesta al tratamiento puede utilizarse amoxicilina/clavulánico para cubrir cepas de H. influenzae y de M. catarrhalis productoras de betalactamasas. Las rinosinusitis son virales en la mayoría de los casos y menos del 5% se complican con sinusitis bacteriana. El diagnóstico es clínico y en general no se requieren estudios complementarios. Los patógenos bacterianos implicados son los mismos que causan OMA, por esta razón también se recomienda la amoxicilina como droga de elección.

Upper respiratory tract infections are the most common source of antibiotic prescriptions. Acute pharyngitis is caused mainly by viruses, viral cases can be distinguished from acute streptococcal pharyngitis using Centor clinical epidemiological criteria, by rapid antigen tests or throat culture. Treatment of choice for streptococcal infection is penicillin V given in two daily doses. In children, acute otitis media (AOM) is the infection for which antibiotics are most often prescribed. Predominant causative pathogens include Streptococcus pneumoniae, Haemophilus influenzae non-type b and Moraxella catarrhalis. Diagnosis is based on history, physical examination and otoscopic exam. Antibiotic treatment should be initiated promptly in all children < 2 years of age, and in older children presenting bilateral AOM, otorrhoea, co-morbidities or severe illness. In Argentina, amoxicillin is the drug of choice given the low penicillin resistance rates for S. pneumoniae. In children who fail amoxicillin therapy, amoxicillin/clavulanate provides better coverage against beta-lactamase producing H. influenzae and M. catarrhalis. Rhinosinusitis is caused mainly by viruses, secondary bacterial complication occurs in less than 5% of cases. Diagnosis is based on physical examination and additional studies are not usually required. Acute bacterial sinusitis is caused by the same pathogens that cause AOM and amoxicillin is the drug of choice.

Evaluation of Iranian pediatric specialists' attitude and knowledge regarding approach to patients with acute otitis media

The ministry of health and medical education of Iran and many other countries advice physicians to use this guideline for diagnosis and treatment of acute otitis media [AOM], but there is not any evaluation of effectiveness and obedience of this guideline, so the aim of this study was to evaluate the attitude of pediatricians, the most important group that interfere with these patients in treatment of acute otitis media. A total of 120 anonymous surveys were mailed to 120 pediatrician in Tehran [Iran] to evaluate pattern of diagnosis and treatment of AOM in these physicians. Age, gender, place of work, attitude of diagnosis and treatment were asked by anonymous survey. Sixty-two completed surveys were received, for a response rate of 51%. There was no significant difference between responders in these survey and scenarios, according to sex, age, practice setting, graduation year or the number of AOM patients visiting each month. Our study seems to add new insights to the previous literature on management of AOM according to guideline. We can assess the impact of guidelines on the usual practice of practitioners in evidenced-based management of AOM

Otitis media aguda / Acute otitis media

La Otitis Media Aguda, (OMA), es una inflamación aguda del espacio del oído medio. Se caracteriza por la acumulación de líquido o secreción purulenta. Es la enfermedad más frecuente en niños, para la cual se usan antibióticos. Se presenta la revisión de la mejor evidencia disponible relacionada con la epidemiología, etiología, diagnóstico clínico y el tratamiento médico y quirúrgico.

The Acute Otitis Media, (AOM), is an acute inflammation of the space of the middle ear. It is characterized by the accumulation of serous or purulent secretion. It is the most frequent disease in children for which antibiotics are used. This is a revision of the best evidence available related to epidemiology, aetiology, clinical diagnosis and the medical and surgical treatment.

Consideraciones sobre la otitis media aguda y la medicina basada en evidencias: ¿Cuál otitis media aguda; cuál medicina y cuáles evidencias? / Otitis media and evidence based medicine: what acute otitis media?; what medicine and which evidences?

A pesar de que la otitis media es una enfermedad de alta incidencia y prevalencia, hay diferencias significativas en las estrategias de tratamiento. Los tratamientos -basados en evidencias estadísticas- han fluctuado desde el uso masivo de antibióticos a tratamiento sintomático sin uso de antibióticos, hasta el momento actual en que se intenta definir quiénes se benefician del uso de ellos y en qué forma y circunstancias. En este artículo se revisan las tendencias cambiantes de tratamiento y se sugieren alternativas de abordaje. Entre otras, se destaca un examen físico adecuado, y el proveer a los pacientes en forma individual con el tratamiento más adecuado para ellos en particular. Se considera a la otitis como una enfermedad multifactorial no susceptible a esquemas únicos y rígidos de tratamiento, y se hace un llamado a los médicos a no aceptar estadísticas a priori sino que a ejercer en todo momento un análisis crítico de las publicaciones y a usar sentido común.

Although otitis media has a high incidence and prevalence, there are significant differences in treatment strategies. Evidence based treatments have fluctuated from universal use of antibiotics to symptomatic treatment without antibiotics, to the present moment of defining who would benefit from their use and under which circumstances. This article reviews these treatment strategies and suggests some approaches in order to deal with this changing situation. Among others, an adequate clinical examination is recommended, along with providing individual patients with the most adequate treatment for them in particular. Since otitis media is a multifactorial disease, it is considered non susceptible to rigid forms of treatment. Physicians are urged not to accept statistical studies without a critical analysis of the data. The use of common sense is recommended.

Abordaje conservador de los pacientes con otitis media aguda / Conservative management of patients with acute media otitis

A partir de la descripción de un caso de otitis media aguda (OMA) infantil se discuten las principales estrategias de abordaje de estos pacientes, especialmente el punto relacionado con evidencia que avala la prescripción inmediata y/o diferida de antibióticos. Se concluye que en los pacientes de bajo riesgo -sintomatología no severa, ausencia de comorbilidades y seguimiento asegurado a las 48 horas- existe suficiente evidencia para avalar el tratamiento sintomático inicial sin prescripción de antibióticos, esperando la resolución espontánea de la enfermedad, que ocurre en más del 80 de los pacientes. Al final de este EOP, resumimos la Guía Inglesa para la prescripción de antibióticos para las infecciones autolimitadas del tracto respiratorio publicada en 2008.

Visual hallucinations possibly associated with clarithromycin administration at therapeutic dosage in two children

Our aim was to present 2 children with visual hallucinations possibly associated with clarithromycin administration at therapeutic dosage. Two children were admitted to our hospital with sudden onset of visual hallucinations after taking clarithromycin at therapeutic dosage by mouth. Physical examination, laboratory investigations and imaging studies were normal. The symptoms gradually disappeared once the clarithromycin therapy had been discontinued, making us suspect clarithromycin as the agent responsible for the visual hallucinations. They were observed monthly for a year without any symptoms or further treatment. This report highlights hallucinations due to therapeutic doses of clarithromycin therapy as a possible new side effect in children

Presentation and management of children with acute otitis media at primary care level

To determine the patterns of presentation of acute otitis media [AOM] diagnostic ability and antibiotic prescription by family physicians. This is a cross-sectional study conducted at 11 PHCC in Riyadh city in Saudi Arabia over 3 month period. Twenty eight family physicians participated in the study. A total of 135 children, less than 5 years of age and presenting with a new episode of AOM were included. The age group [> 30] months had more children presenting with earache compared to other age groups [p < 0.05]. Redness of the TM had the highest [> 50%] certainty level compared to other TM signs [94%] p < 0.05, while retracted TM had the highest [

Otitis media aguda: Diagnóstico y tratamiento / Acute otitis media: Diagnosis and treatment

Acute otitis media (AOM) is one of the most common causes of medical visit and antimicrobial use in children. A rationale management approach requires a thorough clinical exam and updated knowledge on local patterns of microorganisms involved and antimicrobial susceptibility profiles. Clinical diagnosis should be performed with pneumatic otoscopy. The most common microorganism causing AOM in Santiago, Chile according to local studies are Streptococcus pneumoniae (40 percento), non-capsulated Haemophilus influenzae (29 percent), Streptococcus pyogenes (7 percent) and Moraxella catarrhalis (4 percent). S. pneumoniae has acquired resistance to penicillin in the last decade, resistance that has been extrapolated to other (b lactams such as amoxicillin, reason why broader spectrum antimicrobials are routinely prescribed. Clinical practice has consistently shown although that the great majority of children receiving amoxicillin at a dose of 80-100 mg/kg/day resolve their AOM. Recent studies from our group have demonstrated that resistance to penicillin can not be extrapolated to amoxicillin. In vitro high level resistance to penicillin vs amoxicillin is 18 percent> vs 0.5 percent. Based on this data, our current recommendation for AOM is amoxicillin 80 mg/kg/day, q 12 hours for 10 days in infants and for 5-7 days in children > 2 years of age who have not had an episode within the previous month. For amoxicillin failures, amoxicillin + (b lactam inhibitor or a second generation cephalosporin are recommended, especially in areas with a high prevalence of (b lactam producing H. influenzae and M. catarrhalis. Treatment of children with AOM universally require appropriate follow-up in order to comply with the proposed algorithm.

Otitis media aguda (OMA) es una de las principales causas de consulta y de indicación de antimicrobianos en pediatría. El manejo racional de esta patología implica un diagnóstico acucioso y un conocimiento actualizado de las especies bacterianas involucradas en su etiología y de su susceptibilidad a antimicrobianos. El diagnóstico es clínico, a través de neumo-otoscopia. Los principales agentes involucrados en OMA en estudios hechos en Santiago de Chile son Streptococcus pneumoniae (40 por cientoo), Haemophilus influenzae no capsulado (29 por ciento), Streptococcus pyogenes (7 por ciento) y Moraxella catarrhalis (4 por ciento). S. pneumoniae ha adquirido resistencia a penicilina en la última década, lo que se ha extrapolado a otros (b lactámicos, como amoxicilina, y ha sido el principal argumento para indicar otros antimicrobianos en el manejo de esta patología. Pese a esta observación, en la práctica clínica los pacientes tratados con amoxicilina a dosis de 80 a 100 mg/kg/día responden satisfactoriamente, con mínimos fracasos terapéuticos. Estudios actuales, hechos en nuestro medio muestran que la susceptibilidad a penicilina y amoxicilina no son equivalentes, mostrando resistencia de alto nivel en 18 y 0,5 por ciento> respectivamente. El tratamiento recomendado hoy, de acuerdo con datos nacionales, es amoxicilina, 80 mg/kg/día, fraccionada cada 12 hrs, por 10 días en el lactante y por 5-7 días en niños > de 2 años, sin antecedentes de OMA a repetición. Como alternativa de tratamiento, frente a una falla del mismo, se propone el uso de amoxicilina + inhibidores de (b lactamasas o cefalosporinas de segunda generación en ambientes con alta prevalencia de H. influenzae productores de (b lactamasas y M. catarrhalis. El tratamiento de un niño con OMA implica, necesariamente, control y seguimiento hasta su mejoría.