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1.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1403141

ABSTRACT

Introducción: Las infecciones representan la etiología más frecuente del síndrome febril prolongado (SFP). Si bien las fiebres entéricas constituyen una causa posible, en Uruguay su prevalencia ha disminuido significativamente con la mejora de las condiciones socio sanitarias. Objetivo: Comunicar el caso de un adolescente con una etiología actualmente excepcional de SFP. Caso clínico 14 años, sano, zona suburbana. Comienza 2 semanas previo al ingreso con dolor en hemiabdomen superior. Agrega cefalea holocraneana leve y vómitos ocasionales. 5 días previos al ingreso fiebre 40°C axilar, un pico diario, sin otra sintomatología. Tránsito digestivo bajo y urinario normal. Examen físico: lúcido, buen aspecto general, abdomen doloroso a la palpación profunda en epigastrio. Sin irritación peritoneal. Resto normal. Analítica: Leucocitos 5200mm3, Proteína C reactiva 71.4mg/dL, hemocultivo sin desarrollo. Ecografía abdominal, radiografía de tórax y ecocardiograma normales. Serologías para Virus Epstein Barr, Citomegalovirus, y Bartonella henselae negativas. Orina normal, urocultivo sin desarrollo. Persiste con fiebre, agrega exantema macropapular evanescente en tronco, sin otros síntomas. Al 7° día de internación nuevo hemocultivo: Salmonella Typhi sensible a ampicilina que recibe por 14 días. Buena evolución. Discusión: La fiebre tifoidea es una enfermedad infectocontagiosa, aguda, potencialmente mortal. Las condiciones socioeconómicas son determinantes en su transmisión. La sensibilidad del hemocultivo es mayor durante la primera semana de enfermedad, por lo que en ocasiones es necesario reiterarlo. Sus manifestaciones clínicas inespecíficas y la baja incidencia hacen que esta etiología no sea habitualmente sospechada en nuestro medio. Por tanto, es importante aumentar el índice de sospecha y considerar entre los diagnósticos diferenciales de SFP esta etiología.


Introduction: Infections are the most frequent etiology of prolonged febrile illness (PFI). Although enteric fevers are a possible cause, their prevalence has significantly diminished in Uruguay, due to improved socio-sanitary conditions. Objective: To communicate the case of an adolescent with a currently exceptional etiology of PFI. Clinical case: 14 years old, healthy, suburban area. Two days prior to admission the patient has pain in upper hemi abdomen. Adds mild holocranial headache and occasional vomiting. 5 days prior to admission axilary temperature of 40°C, one daily peak, without other symptoms. Normal lower digestive and urinary transit. Physical examination: lucid, good general aspect, pain at deep palpation in epigastrium. No peritoneal irritation. Rest is normal. Laboratory: leukocytes 5200 mm3, C-reactive protein 71.4mg/dL, blood culture shows no growth. Abdominal sonogram, thoracic X-ray and echocardiogram are normal. Negative serology for Epstein Barr Virus, Cytomegalovirus and Bartonella henselae. Normal urine, urine culture with no growth. Fever persists, adds evanescent macropapular exanthema in on the trunk, without other symptoms. On the 7th day in hospital a new blood culture shows Salmonella Typhi sensitive to ampicillin, which he receives for 14 days. Good evolution. Discussion: Typhoid fever is an acute, life-threatening, infectious disease. Socioeconomic conditions are determinant in its transmission. Blood culture sensitivity is greater during the first week of the disease, that is why it must occasionally be repeated. Its unspecific clinical manifestations and low incidence make this etiology not be usually suspected in our surroundings. It is therefore important to increase our suspicion and to consider it amongst differential diagnosis in PFI.


Introdução: As infecções representam a etiologia mais frequente da síndrome febril prolongada (SFP). Embora as febres entéricas sejam uma causa possível, no Uruguai sua prevalência diminuiu significativamente com a melhoria das condições sociossanitárias. Objetivo: Relatar o caso de um adolescente com etiologia atualmente excepcional de SFP. Caso clínico 14 anos, saudável, zona suburbana. Começa 2 semanas antes da admissão com dor no abdome superior. Adiciona dor de cabeça holocraniana leve e vômitos ocasionais. 5 dias antes da admissão febre 40°C axilar, pico diário, sem outros sintomas. Trânsito digestivo inferior e trânsito urinário normais. Exame físico: lúcido, bom aspecto geral, abdome doloroso à palpação profunda no epigástrio. Sem irritação peritoneal. Resto normal. Análise: Leucócitos 5200mm3, proteína C reativa 71,4mg/dL, hemocultura sem desenvolvimento. Ultrassonografia abdominal, radiografia de tórax e ecocardiograma foram normais. As sorologias para vírus Epstein Barr, Citomegalovírus e Bartonella henselae foram negativas. Urina normal, urocultura sem desenvolvimento. Persiste com febre, acrescenta erupção macropapular evanescente no tronco, sem outros sintomas. No 7º dia de internação, nova hemocultura: Salmonella Typhi sensível à ampicilina, que recebeu por 14 dias. Boa evolução. Discussão: A febre tifóide é uma doença infecciosa aguda, potencialmente fatal. As condições socioeconômicas são decisivas na sua transmissão. A sensibilidade da hemocultura é maior durante a primeira semana da doença, por isso às vezes é necessário repeti-la. Suas manifestações clínicas inespecíficas e baixa incidência fazem com que essa etiologia não seja usualmente suspeitada em nosso meio. Portanto, é importante aumentar o índice de suspeição e considerar essa etiologia entre os diagnósticos diferenciais da SFP.


Subject(s)
Humans , Male , Adolescent , Typhoid Fever/diagnosis , Fever of Unknown Origin/etiology , Syndrome , Typhoid Fever/drug therapy , Amoxicillin/administration & dosage , Ampicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage
2.
Article in Spanish | LILACS | ID: biblio-1281082

ABSTRACT

La otitis media aguda (OMA) es una patología muy común en pediatría y constituye la indicación más frecuente de prescripción de antibióticos en la infancia. Para el diagnóstico se tienen en cuenta hallazgos en la otoscopia, diversos signos clínicos y el tiempo de evolución de los síntomas principales. La decisión de iniciar antibioticoterapia debe determinarse según cada paciente. La espera vigilante como alternativa a la antibioticoterapia inmediata en casos seleccionados reduce el uso de antibióticos sin aumentar el riesgo de daño al paciente y ha demostrado ser una medida costo-efectiva. El fármaco de elección para el tratamiento empírico de la OMA es la amoxicilina, aunque según nuestros resultados es la amoxicilina-IBL la utilizada como primera línea en ambos servicios.


Acute otitis media (AOM) is a pathology commonly found in pediatrics, and the most frequent cause of antibiotics prescription in infants. For its diagnostics, several criteria are taken in consideration, such as otoscopy observations, diverse clinical signs, and the time of evolution of the main symptoms. The decision to initiate antibiotic therapy must be determined particularly for each patient. As an alternative to immediate antibiotic therapy, watchful waiting is preferred in certain cases to reduce the antibiotic use without elevating the patients' risk and has been proven to be a cost-effective approach. The preferred drug for empiric antibiotic therapy in AOM is amoxicillin, although we have observed that the first choice in both our services, pediatrics and otorhinolaryngology, is amoxicillin-IBL.


Subject(s)
Otitis Media , Otoscopy , Amoxicillin , Otolaryngology , Pediatrics , Signs and Symptoms , Diagnosis
3.
Rev. méd. hondur ; 89(1): 10-16, 2021. tab
Article in Spanish | LILACS | ID: biblio-1282992

ABSTRACT

Antecedentes: Las recomendaciones de esquemas para erradicar Helicobacter pylori se encuentran ampliamente dis- ponibles. Este es un patógeno de alta prioridad para búsqueda y desarrollo de nuevos y efectivos tratamientos. Objetivo: Descri- bir la respuesta terapéutica con terapia de rescate para infección por H. pylori, Hospital Escuela, Tegucigalpa, diciembre 2016-abril 2017. Métodos: Estudio descriptivo longitudinal retrospectivo en pacientes consecutivos con sintomatología gastrointestinal e in- fección conirmada por H. pylori. Mediante el registro del Servi- cio de Gastroenterología, Departamento de Medicina Interna, se identiicaron pacientes positivos por H. pylori. Se registraron datos sociodemográicos, clínicos y diagnósticos. El tratamiento de res- cate brindado fue, vía oral por 10 días: levoloxacina 500 mg/día, esomeprazol 40 mg dos veces/día, amoxicilina 1 gr dos veces/ día. La conirmación de la erradicación fue realizada 4-8 semanas postratamiento. Se registró información sobre la adherencia al tra- tamiento y los efectos secundarios. Resultados: Se analizaron 30 casos; 56.7% (17) pacientes nuevos y 43.3% (13) pacientes con al menos un fracaso. En el 16.0% (5) no hubo conirmación de erra- dicación; se obtuvo una tasa de erradicación del 72.0% (18/25), IC95% 50.6-87.9; siendo 78.5% (11/14) en pacientes nuevos ver- sus 63.6% (7/11) en fracasos previos, IC95% -9.6-54.0, p=0.318. Discusión: La tasa de erradicación en este grupo de pacientes no fue satisfactoria. Actualmente el tratamiento con levoloxacina es recomendado como terapia de segunda línea o de rescate en regiones con baja o alta resistencia a la claritromicina, aunque la resistencia a quinolonas ha aumentado en los últimos años en va- rios países...(AU)


Subject(s)
Humans , Adult , Helicobacter pylori/pathogenicity , Gastrointestinal Diseases/complications , Levofloxacin/therapeutic use , Amoxicillin/therapeutic use
4.
Rev. méd. Minas Gerais ; 31: 31406, 2021.
Article in Portuguese | LILACS | ID: biblio-1291372

ABSTRACT

A proteinose alveolar pulmonar (PAP) é rara e caracterizada por preenchimento alveolar com material lipoproteináceo. A proteinose alveolar é caracterizada por um alvéolo com material eosinofílico, acelular, finamente granular, com fendas de colesterol. Este relato de caso descreve um paciente do sexo masculino, 2 anos, portador de hipogamaglobulinemia. O paciente foi internado com quadro compatível com Stevens- Johnson após uso de amoxicilina e clavulanato para quadro de otite média aguda. Posteriormente, foi encaminhado à unidade de terapia intensiva devido à piora respiratória clínica e radiológica. Biópsia pulmonar: proteinose alveolar com alvéolos distendidos por material proteináceo, eosinofílico e grumoso com infiltrado linfo- histiocitário local. A proteinose alveolar pulmonar é rara e o diagnóstico correto deve ser realizado para que seja realizado tratamento adequado e acompanhamento da evolução. Deve-se atentar para complicações, especialmente infecções oportunistas.


Pulmonary alveolar proteinosis (PAP) is rare and it is characterized by alveolar filling with lipoproteinaceous material. Alveolar proteinosis is characterized by an alveolus with eosinophilic, acellular, finely granular material, with cholesterol cracks. This case report describes a 2-yearold male patient with hypogammaglobulinemia. The patient was hospitalized with Stevens-Johnson-compatible condition after use of amoxicillin and clavulanate for acute otitis media. Subsequently, he was referred to the intensive care unit due to worsening clinical and radiological breathing. Lung biopsy: alveolar proteinosis with alveoli distended by proteinaceous, eosinophilic and lumpy material with local lymphohistiocytic infiltrate. Pulmonary alveolar proteinosis is rare and the correct diagnosis must be made in order to carry out an appropriate treatment and follow-up of the evolution. Attention should be paid to complications, especially opportunistic infections.


Subject(s)
Male , Child, Preschool , Pulmonary Alveolar Proteinosis , Respiratory Distress Syndrome, Newborn , Opportunistic Infections , Dyspnea , Tachypnea , Familial Primary Pulmonary Hypertension , Amoxicillin
5.
J. appl. oral sci ; 29: e20210171, 2021. tab, graf
Article in English | LILACS | ID: biblio-1350892

ABSTRACT

Abstract Some evidence in vitro suggested that amoxicillin and fluoride could disturb the enamel mineralization. Objective: To assess the effect of amoxicillin and of the combination of amoxicillin and fluoride on enamel mineralization in rats. Methodology: In total, 40 rats were randomly assigned to four groups: control group (CG); amoxicillin group (AG - amoxicillin (500 mg/kg/day), fluoride group (FG - fluoridated water (100 ppm -221 mg F/L), and amoxicillin + fluoride group (AFG). After 60 days, the samples were collected from plasma and tibiae and analyzed for fluoride (F) concentration. The incisors were also collected to determine the severity of fluorosis using the Dental Fluorosis by Image Analysis (DFIA) software, concentration of F, measurements of enamel thickness, and hardness. The data were analyzed by ANOVA, Tukey's post-hoc test, or Games-Howell post-hoc test (α=0.05). Results: Enamel thickness of the incisors did not differ statistically among the groups (p=0.228). Groups exposed to fluoride (AFG and FG) have higher F concentrations in plasma, bone and teeth than those not exposed to fluoride (CG and AG). The groups showed a similar behavior in the DFIA and hardness test, with the FG and AFG groups showing more severe fluorosis defects and significant lower hardness when compared with the AG and CG groups, with no difference from each other. Conclusion: The rats exposed to fluoride or fluoride + amoxicillin developed dental fluorosis, while exposure to amoxicillin alone did not lead to enamel defects.


Subject(s)
Animals , Rats , Fluorides/toxicity , Fluorosis, Dental/etiology , Dental Enamel , Hardness , Amoxicillin/toxicity , Incisor
6.
Rev. colomb. gastroenterol ; 35(3): 351-361, jul.-set. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138793

ABSTRACT

Resumen Helicobacter pylori (H. pylori) es un bacilo gramnegativo microaerófilo, capaz de colonizar la mucosa gástrica. Este microorganismo infecta a más de la mitad de la población mundial, por lo que se ha convertido en la infección bacteriana más común. La prevalencia de la infección y de las enfermedades asociadas a ella es alta, sobre todo en países en vías de desarrollo. El tratamiento recomendado para la erradicación es la triple terapia; sin embargo, su eficacia ha disminuido por el desconocimiento del patrón de susceptibilidad bacteriano por parte del personal médico y dada la aparición de cepas resistentes. La resistencia en H. pylori se asocia con la capacidad de adaptación de la bacteria a ambientes hostiles y al uso de los antibióticos. En Colombia, existen reportes acerca de que H. pylori presenta resistencia a amoxicilina, metronidazol, claritromicina, furazolidona, levofloxacina y tetraciclina. Los estudios del patrón de susceptibilidad determinaron que la frecuencia de resistencia de H. pylori es variable y demuestran la falta de datos en la mayoría del territorio del país. Sobre la base de lo anterior, el objetivo de esta revisión es describir los porcentajes de resistencia de H. pylori a los antibióticos amoxicilina, metronidazol, claritromicina, furazolidona, levofloxacina y tetraciclina, usados en el tratamiento de la infección en los estudios realizados en Colombia.


Abstract Helicobacter pylori (H. pylori) is a microaerophilic gram-negative bacillus that colonizes the gastric mucosa. It infects more than half the world's population, making it the most common bacterial infection. The prevalence of infection and associated diseases is high in developing countries. The recommended treatment for its eradication is triple therapy; however, its efficacy has decreased due to the lack of knowledge of the bacterial susceptibility pattern among the medical staff and the emergence of resistant strains. H. pylori susceptibility is associated with the bacteria's ability to adapt to hostile environments and the use of antibiotics. In Colombia, it has been reported that H. pylori is resistant to amoxicillin, metronidazole, clarithromycin, furazolidone, levofloxacin, and tetracycline. Studies on the susceptibility pattern have determined that the frequency of H. pylori susceptibility is variable and demonstrate the lack of data in most of the Colombian territory. With this in mind, the objective of this review is to describe the percentage of resistance to amoxicillin, metronidazole, clarithromycin, furazolidone, levofloxacin and tetracycline, which are used for the treatment of H. pylori infection, according to studies conducted in Colombia.


Subject(s)
Humans , Tetracycline , Efficacy , Helicobacter pylori , Clarithromycin , Levofloxacin , Furazolidone , Amoxicillin , Metronidazole , Prevalence , Disease Susceptibility , Disease Eradication
7.
Brasília; s.n; 20 jul.2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1117679

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referentes ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 14 artigos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Ribavirin/therapeutic use , Technology Assessment, Biomedical , Vitamin D/therapeutic use , Immunoglobulins/therapeutic use , Dexamethasone/therapeutic use , Methylprednisolone/therapeutic use , Prednisone/therapeutic use , Roxithromycin/therapeutic use , Cross-Sectional Studies/instrumentation , Cohort Studies , Interferons/therapeutic use , Azithromycin/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Peptidyl-Dipeptidase A/therapeutic use , Ritonavir/therapeutic use , Oseltamivir/therapeutic use , Lopinavir/therapeutic use , Amoxicillin/therapeutic use , Hydroxychloroquine/therapeutic use
8.
Brasília; s.n; 7 jul. 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1117630

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 17 artigos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Steroids/therapeutic use , Technology Assessment, Biomedical , Vitamin D/therapeutic use , Warfarin/therapeutic use , Ivermectin/therapeutic use , Ceftriaxone/therapeutic use , Chloroquine/therapeutic use , Methotrexate/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Azithromycin/therapeutic use , Ritonavir/therapeutic use , Oseltamivir/therapeutic use , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Lopinavir/therapeutic use , Infliximab/therapeutic use , Leflunomide/therapeutic use , Amoxicillin/therapeutic use , Hydroxychloroquine/therapeutic use , Mycophenolic Acid/therapeutic use
9.
Brasília; s.n; 18 maio 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1097390

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 22 artigos e 10 protocolos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Disease Progression , Betacoronavirus/drug effects , Immunoglobulins/therapeutic use , Methylprednisolone/therapeutic use , Nifedipine/therapeutic use , Chloroquine/therapeutic use , Amlodipine/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Azithromycin/therapeutic use , Ritonavir/therapeutic use , Fluoroquinolones/therapeutic use , Drug Combinations , Lopinavir/therapeutic use , Interferon alpha-2/therapeutic use , Amoxicillin/therapeutic use , Hydroxychloroquine/therapeutic use
10.
Con-ciencia (La Paz) ; 8(1): 33-52, 20200400. ilus, tab
Article in Spanish | LILACS, LIBOCS | ID: biblio-1178435

ABSTRACT

INTRODUCCIÓN: el metronidazol, antiparasitario y antimicrobiano, y la amoxicilina, aminopenicilina de amplio espectro, son medicamentos de amplio uso. OBJETIVOS: determinar la calidad farmacéutica de formulaciones de administración oral disponibles en el mercado hondureño, en la ciudad de Tegucigalpa. MÉTODOS: se analizaron productos de cinco marcas de comprimidos de metronidazol 500 mg y cápsulas de amoxicilina 500 mg, respectivamente, todas ellas dentro de su período de validez de uso. Se evaluaron las propiedades tecnológicas y químicas de las tabletas y cápsulas, tales como peso pro-medio, dureza, valoración, uniformidad de contenido, ensayo de disolución, perfil de disolución, área bajo la curva y eficiencia de la disolución. RESULTADOS: no todas las especialidades medicinales contenían la información sobre las condiciones de almacenamiento, respecto a la temperatura, luz y humedad, declarados en los rótulos y prospectos. De acuerdo a la evaluación tecnológica y química, todos los productos evaluados cumplieron con las especificaciones de la farmacopea. Sin embargo, existen diferencias estadísticamente significativas entre los productos según las pruebas de disolución in vitro. La liberación del metronidazol se ajustó al modelo de Hixson Crowell, mientras que la de amoxicilina, en dos formulaciones se ajustó al modelo de Higuchi, y en el resto al modelo de Hixson-Crowell. CONCLUSIONES: se sugiere la necesidad de una mayor vigilancia a los medicamentos que se comercializan en el país con el fin de verificar el cumplimiento de los estándares de calidad.


INTRODUCTION: metronidazole, an antiparasitic and antimicrobial, and amoxicillin, a broad-spectrum aminopenicillin, are widely used drugs. Aims: to determine the pharmaceutical quality of oral administration formulations available in the Honduran market, in the city of Tegucigalpa. METHODS: products from five brand of metronidazole tablets (500 mg) and amoxicillin capsules (500 mg) were analyzed, respectively, all of them within their period of validity of use. For this, the technological, chemical and chemical properties of the tablets and capsules were evaluated, such as average weight, hardness, evaluation of active principle, uniformity of content, dissolution test, dis-solution profile, area under curve and dissolution efficiency. RESULTS: not all medicinal specialties contained information on storage conditions, regarding temperature, light and humidity, stated on the labels and leaflets. According to the technological and chemical evaluation, all the evaluated products satisfied the specifications of the pharmacopeia. However, there are statistically significant differences between the products according to in vitro dissolution tests. The release of metronidazole was adjusted to the Hixson-Crowell model, while that of amoxicillin, in two formulations was adjusted to the Higuchi model, and in the rest to the Hix-son-Crowell model. CONCLUSIONS: The need for greater surveillance of the drugs that are marketed in the country is suggested, in order to verify compliance with quality standards.


Subject(s)
Total Quality Management , Amoxicillin , In Vitro Techniques , Dissolution
11.
Medicina (B.Aires) ; 80(2): 111-116, abr. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1125050

ABSTRACT

La resistencia bacteriana a ciertos antibióticos condiciona el éxito del tratamiento erradicador de la infección gástrica por Helicobacter pylori y es motivo de creciente preocupación a nivel mundial. Dada la escasa evidencia publicada en Argentina sobre este tema, nuestro objetivo fue investigar factores asociados a la persistencia de H. pylori post-tratamiento antibiótico. Se determinó la frecuencia de fracaso terapéutico en 81 pacientes con gastritis por H. pylori tratados en nuestro Servicio y sometidos al estudio de urea en aire espirado para confirmar la erradicación de la infección. La edad promedio fue 58±12 y 43.2% eran hombres. La frecuencia de fracaso terapéutico fue 17.3%. De los dos esquemas más utilizados, la frecuencia de fracaso fue mayor con claritromicina + amoxicilina que con levofloxacina + amoxicilina (25% vs. 6.6%, p=0.04). Como factores de riesgo investigamos las siguientes variables: edad, género, síntomas, tabaquismo, consumo de anti-inflamatorios, diabetes, obesidad, tipo y duración de tratamiento. En el análisis univariado, el uso de esquemas con claritromicina y el género masculino se asociaron significativamente a persistencia de la infección [OR 4.2 (1.1-15.6) y 5.2 (1.1-26.4)]. En el análisis multivariado, el uso de esquema con claritromicina permaneció asociado al fracaso terapéutico [OR 5.38 (1.1-29.5)]. Concluimos que la inclusión de claritromicina en el esquema terapéutico para la gastritis por H. pylori se asoció a mayor fracaso terapéutico. Este fracaso es atribuible a alta prevalencia de resistencia de H. pylori a ese antibiótico en la población atendida en nuestro hospital y cuestiona las prácticas habituales de tratamiento en nuestro medio.


Antibiotic resistance may hinder the efficacy of eradication therapy against Helicobacter pylori infection and it has become a major concern worldwide. Due to the relatively scarce evidence published in Argentina on this topic, our aim was to describe factors associated with H. pylori persistence after antibiotic treatment. The therapeutic failure rate was described among 81 patients with H. pylori gastritis treated in our Hospital with a post-treatment urea breath test to determine successful eradication. Mean age was 58 ± 12 and 43.2% were male subjects. H. pylori persistence was observed in 17.3% of subjects. Therapeutic failure was more common among patients receiving clarithromycin + amoxicillin therapy that among those receiving levofloxacin + amoxicillin (25% vs. 6.6%, p = 0.04). The following variables were assessed: age, gender, referral symptoms, smoking, anti-inflammatory use, diabetes, obesity, treatment type and duration. Clarithromycin-based therapy and male gender were associated with infection persistence on univariate analysis [OR 4.2 (1.1-15.6) and 5.2 (1.1-26.4)]. On multivariate analysis, clarithromycin-based was associated with infection persistence [5.38 (1.1-29.5)]. We conclude that clarithromycin-based therapy is significantly associated with treatment failure. This failure may be due to an elevated prevalence of H. pylori resistance to clarithromycin in the population under study and raises the question on the utility of such therapeutic alternative.


Subject(s)
Humans , Male , Female , Middle Aged , Helicobacter Infections/drug therapy , Drug Resistance, Bacterial , Gastritis/drug therapy , Anti-Bacterial Agents/therapeutic use , Argentina , Cross-Sectional Studies , Retrospective Studies , Helicobacter pylori , Helicobacter Infections/microbiology , Treatment Failure , Clarithromycin/therapeutic use , Drug Therapy, Combination , Levofloxacin/therapeutic use , Gastritis/microbiology , Amoxicillin/therapeutic use
12.
Arch. argent. pediatr ; 118(1): 47-51, 2020-02-00. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1095576

ABSTRACT

La amoxicilina es un antibiótico betalactámico comúnmente indicado en pediatría y es la causa más frecuente de alergia a medicamentos.Objetivos. Determinar la proporción de alergia confirmada a amoxicilina en niños con sospecha diagnóstica, atendidos en una sección de alergia pediátrica.Población y métodos. Estudio descriptivo retrospectivo entre enero de 2009 y enero de 2017, en menores de 18 años con sospecha diagnóstica de alergia a amoxicilina. Se realizó el diagnóstico según interrogatorio y pruebas específicas.Resultados. Fueron incluidos 234 pacientes; se diagnosticó alergia a la amoxicilina en el 10,7 % (intervalo de confianza del 95 %: 7-15). Estos pacientes tenían mayor prevalencia de síntomas inmediatos (el 40 % vs. el 22 %, p = 0,048) y de exposición previa a betalactámicos (el 84 % vs. el 56 %, p = 0,007).Conclusión. La confirmación de alergia a la amoxicilina en niños derivados a especialistas fue del 10,7 %.


Amoxicillin is a beta-lactam antibiotic commonly indicated in pediatrics and the most frequent cause of drug allergies.Objectives. To determine the proportion of confirmed amoxicillin allergy in children with diagnostic suspicion seen at the Division of Pediatric Allergy.Population and methods. This descriptive, retrospective study was done between January 2009 and January 2017 in children younger than 18 years with diagnostic suspicion of amoxicillin allergy. The diagnosis was based on questions and specific tests.Results. A total of 234 patients were included; amoxicillin allergy was diagnosed in 10.7 % (95 % confidence interval: 7-15). These patients had a higher prevalence of immediate symptoms (40 % vs. 22 %, p = 0.048) and prior exposure to beta-lactams (84 % vs. 56 %, p = 0.007).Conclusion. Amoxicillin allergy in children referred to specialists was confirmed in 10.7 %.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Drug Hypersensitivity/diagnosis , Hypersensitivity , Epidemiology, Descriptive , Retrospective Studies , beta-Lactams , Amoxicillin
13.
Pesqui. vet. bras ; 40(1): 29-38, Jan. 2020. tab, graf, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1091660

ABSTRACT

Salmonella Infantis is frequently associated with human infections worldwide and is transmitted by consumption of contaminated foods, particularly those of animal origin, especially the chicken meat. We aimed to evaluate virulence characteristics, antimicrobial resistance and the genetic similarity of 51 strains of S. Infantis isolated from samples of poultry origin. The strains were isolated from 2009 to 2010 in a company with full cycle of broiler's production in the state of São Paulo, Brazil. The antimicrobial susceptibility test was performed and, by PCR, we evaluated the presence of the genes lpfA (hem-adhesion), agfA (hem-biofilm) and sefA (hem-adhesion) and resistance genes to beta-lactams (blaTEM, blaSHV, bla CTX-M and blaAmpC ). The phylogenetic relationship was determined by RAPD-PCR method. Among the drugs tested, the highest percentages of resistance were to amoxicillin (35.3%) and to sulfonamide (15.7%). Eleven antimicrobial resistance patterns were identified (A1 to A11), none of them presented a multiresistance profile (> 3 antimicrobials classes). There was 100% of positivity for the agfA gene, 92.2% for the lpfA gene, and no strain presented the sefA gene. Most of the isolates showed similarities in virulence potential, since they were simultaneously positive for two studied genes, agfA and lpfA (92.2%, 47/51). Of the 18 (35.3%) strains resistant to antimicrobials of the β-lactam class, 10 (55.5%) were positive to blaAmpC gene, five (27.8%) for blaCTX-M , two (11.1%) to blaSHV and no strain presented the blaTEM gene. The phylogenetic evaluation has shown the presence of five clusters (A, B, C, D and E) with similarity greatSalmonella Infantis is frequently associated with human infections worldwide and is transmitted by consumption of contaminated foods, particularly those of animal origin, especially the chicken meat. We aimed to evaluate virulence characteristics, antimicrobial resistance and the genetic similarity of 51 strains of S. Infantis isolated from samples of poultry origin. The strains were isolated from 2009 to 2010 in a company with full cycle of broiler's production in the state of São Paulo, Brazil. The antimicrobial susceptibility test was performed and, by PCR, we evaluated the presence of the genes lpfA (hem-adhesion), agfA (hem-biofilm) and sefA (hem-adhesion) and resistance genes to beta-lactams (blaTEM, blaSHV, bla CTX-M and blaAmpC ). The phylogenetic relationship was determined by RAPD-PCR method. Among the drugs tested, the highest percentages of resistance were to amoxicillin (35.3%) and to sulfonamide (15.7%). Eleven antimicrobial resistance patterns were identified (A1 to A11), none of them presented a multiresistance profile (> 3 antimicrobials classes). There was 100% of positivity for the agfA gene, 92.2% for the lpfA gene, and no strain presented the sefA gene. Most of the isolates showed similarities in virulence potential, since they were simultaneously positive for two studied genes, agfA and lpfA (92.2%, 47/51). Of the 18 (35.3%) strains resistant to antimicrobials of the ß-lactam class, 10 (55.5%) were positive to blaAmpC gene, five (27.8%) for blaCTX-M , two (11.1%) to blaSHV and no strain presented the blaTEM gene. The phylogenetic evaluation has shown the presence of five clusters (A, B, C, D and E) with similarity greater than 80%, and three distinct strains which were not grouped in any cluster. Cluster B grouped 33 strains, all positive for lpfA and agfA genes, from both, the broiler farming facility and the slaughterhouse, persistent throughout all the study period. This cluster also grouped 18 strains clones with genetic similarity greater than 99%, all isolated in the slaughterhouse. The presence of virulence genes associated with persistent strains clones for a long period, warns to the possibility of S. Infantis to form biofilm, and should be constantly monitored in broilers' production chain, in order to know the profile of the strains that may contaminate the final product and evaluate the hazards that represents to public health.er than 80%, and three distinct strains which were not grouped in any cluster. Cluster B grouped 33 strains, all positive for lpfA and agfA genes, from both, the broiler farming facility and the slaughterhouse, persistent throughout all the study period. This cluster also grouped 18 strains clones with genetic similarity greater than 99%, all isolated in the slaughterhouse. The presence of virulence genes associated with persistent strains clones for a long period, warns to the possibility of S. Infantis to form biofilm, and should be constantly monitored in broilers' production chain, in order to know the profile of the strains that may contaminate the final product and evaluate the hazards that represents to public health.(AU)


Salmonella Infantis é frequentemente associada a infecções humanas no mundo todo sendo transmitida pelo consumo de alimentos contaminados, principalmente aqueles de origem animal, com destaque para a carne de frango. Objetivou-se avaliar características de virulência, resistência antimicrobiana e a similaridade genética de 51 estirpes de S. Infantis isoladas em amostras de origem avícola. As estirpes foram isoladas no período de 2009 a 2010 em uma empresa com ciclo completo de produção de frango de corte, localizada no estado de São Paulo, Brasil. Foi realizado o teste de susceptibilidade antimicrobiana e pela técnica de PCR, foi avaliada a presença dos genes lpfA (fímbria-adesão), agfA (fímbria-biofilme) e sefA (fímbria-adesão) e os genes de resistência aos beta-lactâmicos (bla TEM, blaSHV, blaCTX-M e blaAmpC ). A relação filogenética foi determinada pelo método de RAPD-PCR. Dentre as drogas testadas, os maiores percentuais de resistência foram para amoxacilina com 35,3% e sulfonamida com 15,7%. Onze perfis de resistência aos antimicrobianos foram identificados (A1 a A11), sendo que nenhum deles apresentou perfil de multirresistência (>3 classes de antimicrobianos). Houve 100% de positividade para o gene agfA, 92,2% para o gene lpfA e nenhuma estirpe apresentou o gene sefA. A maioria dos isolados apresentaram semelhanças no potencial de virulência, pois foram positivos simultaneamente para dois genes estudados, agfA e lpfA (92,2% - 47/51). Das 18 (35,3%) estirpes resistentes aos antimicrobianos da classe dos ß-lactâmicos, 10 (55,5%) foram positivas para o gene blaAmpC , cinco (27,8%) para blaCTX-M , duas (11,1%) para blaSHV e nenhuma estirpe apresentou o gene bla TEM . A avaliação filogenética demonstrou a presença de cinco clusters (A, B, C, D e E) com similaridade superior a 80%, e três estirpes distintas que não foram agrupadas em nenhum dos clusters. O cluster B agrupou 33 estirpes, todas positivas para os genes lpfA e agfA, provenientes tanto do aviário quanto do matadouro frigorífico, persistentes durante todo o período do estudo. Este cluster ainda agrupou 18 estirpes clones com similaridade genética superior a 99%, todas isoladas no matadouro frigorífico. A presença dos genes de virulência, associada à persistência das estirpes clones durante um longo período do estudo, alertam para a possibilidade de S. Infantis em formar biofilme, devendo ser constantemente monitorada na cadeia de produção avícola, especialmente no ambiente de abate, de forma a conhecer o perfil das estirpes que podem contaminar o produto final e assim avaliar os perigos que representam para a saúde pública.(AU)


Subject(s)
Animals , Salmonella/isolation & purification , Salmonella/genetics , Salmonella/pathogenicity , Salmonella Infections, Animal , Drug Resistance, Microbial/genetics , Chickens/microbiology , beta-Lactams , Amoxicillin , Salmonella Infections
14.
Int. j. odontostomatol. (Print) ; 14(3): 448-456, 2020. tab, graf
Article in English | LILACS | ID: biblio-1114920

ABSTRACT

Enterococci are important nosocomial pathogens due to their intrinsic multiresistance and the acquisition of new antibiotic resistance genes (ARG). Enterococcus faecalis has been shown to be one of the main pathogens in persistent endodontic infections, therefore, the main objective of this study was to evaluate the phenotype and resistance genotype of strains of E. faecalis isolated from teeth with persistent endodontic lesions, to the most commonly prescribed antibiotics in dentistry. Thirteen strains of E. faecalis of different pulsotype were analyzed to evaluate the susceptibility to antibiotics, amoxicillin, amoxicillin/clavulanic acid, tetracycline, erythromycin and metronidazole, using the Epsilometer test (E- test) and the presence of beta-lactamases with nitrocefin test. Finally, the detection of ARG was performed with a molecular polymerase chain reaction (PCR) technique and confirmed by the sequencing of the amplification products. Fisher's exact test was used, using 95 % confidence. Regarding the phenotype of resistance, the evaluated strains, independent of the pulsotype, were totally resistant to the action of metronidazole. Antibiotics with higher minimum inhibitory concentration (MIC) after metronidazole include tetracycline and erythromycin. In contrast, lower MIC are applied to the combination of amoxicillin with clavulanic acid. The nitrocefin test was positive only in one strain. Genotypically, two genetically distant strains isolated from a single patient, presented a genotype of resistance to erythromycin, determined by the presence of the ermB gene. No statistically significant relationship was found between phenotypic resistance and the presence of ARG in relation to erythromycin (p> 0.05). It was concluded that isolates of E. faecalis from persistent endodontic infections showed phenotypes of resistance to several antimicrobial agents, all of which were susceptible to amoxicillin/clavulanic acid. Periodic evaluation of susceptibility to antibiotics is suggested as an important practice for the surveillance of antibiotic resistance in oral strains.


Los enterococos son importantes patógenos nosocomiales debido a su multi resistencia intrínseca y la adquisición de nuevos genes de resistencia a los antibióticos (ARG). Enterococcus faecalis es uno de los principales patógenos en infecciones endodónticas persistentes, por lo tanto, el objetivo principal de este estudio fue evaluar el fenotipo y el genotipo de resistencia de cepas de E. faecalis aisladas de dientes con lesiones endodóncicas persistentes, a los antibióticos comúnmente recetados en odontología. Se analizaron 13 cepas de E. faecalis de diferentes pulsotipos para evaluar la susceptibilidad a los antibióticos, amoxicilina, amoxicilina / ácido clavulánico, tetraciclina, eritromicina y metronidazol, utilizando la prueba de Epsilometría (E-test) y la presencia de beta-lactamasas con prueba de nitrocefina. Finalmente, la detección de ARG se realizó con una técnica molecular de reacción en cadena de la polimerasa (PCR) y se confirmó mediante la secuenciación de los productos de amplificación. Se utilizó la prueba exacta de Fisher, con un 95 % de confianza. En cuanto al fenotipo de resistencia, las cepas evaluadas, independientes del pulsotipo, fueron totalmente resistentes a la acción del metronidazol. Los antibióticos con los valores más altos de concentración mínima inibitoria (CMI) después del metronidazol incluyen tetraciclina y eritromicina. En contraste, las CMI mas bajas se aplican a la combinación de amoxicilina con ácido clavulánico. La prueba de nitrocefina fue positiva solo en una cepa. Genotípicamente, dos cepas distantes genéticamente, aisladas de un mismo paciente fueron positivas para el gen ermB. No se encontró una relación estadísticamente significativa entre la resistencia fenotípica y la presencia de ARG en relación con la eritromicina (p> 0,05). Se concluyó que los aislamientos de E. faecalis de infecciones endodónticas persistentes mostraron fenotipos de resistencia a varios agentes antimicrobianos, todos los cuales fueron susceptibles a amoxicilina / ácido clavulánico. Se sugiere una evaluación periódica de la susceptibilidad a los antibióticos como una práctica importante para la vigilancia de la resistencia a los antibióticos en las cepas orales.


Subject(s)
Humans , Enterococcus faecalis/drug effects , Enterococcus faecalis/genetics , Dental Pulp Cavity/microbiology , Anti-Bacterial Agents/pharmacology , Tetracycline , Microbial Sensitivity Tests , Erythromycin , Polymerase Chain Reaction , Clavulanic Acid/pharmacology , Drug Resistance, Bacterial/genetics , Amoxicillin/pharmacology , Metronidazole
15.
Acta odontol. Colomb. (En linea) ; 10(2): 100-111, 2020. tab, graf, tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1123480

ABSTRACT

Objetivo: analizar y mejorar las prescripciones de antibióticos por parte de odontólo-gos, a través de una intervención educativa. Método: se realizó un estudio analizando las recetas de prescripción de medicamentos antes y después de la intervención educa-tiva, en el Instituto de Servicios Sociales de la Universidad Nacional del Nordeste. El es-tudio comprendió tres etapas; en la etapa A se identificaron problemas de prescripción, que fueron socializados con los profesionales durante la intervención educativa como parte de la etapa B, cuya modalidad consistió en dos entrevistas presenciales, con talle-res de discusión y debate. En esta se trabajó, además, con el informe de los resultados obtenidos en el análisis de situación de la etapa A. En la etapa C se analizó el impacto de la intervención educativa. Resultados: en la etapa A se observaron 417 recetas con 202 prescripciones de antibióticos, los más indicados fueron azitromicina (31%), amoxicilina con clavulánico (10%) y amoxicilina (8%). La adecuación de prescripción en relación a la indicación fue del 26%. En la etapa C, de un total de 191 recetas, se analizaron 107 rece-tas con prescripción de antibióticos. La amoxicilina fue el medicamento más prescripto (37%); la prescripción de azitromicina disminuyó a 14% y su adecuación fue del 46%. Ello evidenció una mejoría del 20%, la cual fue validada a través del test chi2 (p=0,00). Conclusión: por medio de la intervención educativa presencial es posible mejorar las prescripciones de antibióticos, no obstante se desconoce si el cambio de conducta prescriptiva se mantiene en el tiempo.


Objective: Analyze the antibiotic prescriptions by dentists and improve their prescription through an educational intervention. Method: This study was carried out with an educational intervention, in a Social Services Institute analyzing prescriptions for antibiotics pre- and post-intervention. The study included three stages, the first to identify prescription problems to were presented to professionals during the educational intervention, which included of two face-to-face interviews, with discussion and debate workshops. In the last stage, the impact of the educational intervention was analyzed. Results: Stage A: 417 prescriptions with 202 antibiotic prescriptions were observed, the most indicated were azithromycin (31%); amoxicillin with clavulanic (10%) and amoxicillin (8%). The adequacy of prescription concerning the indication was 26%; stage B corresponded to the educational intervention, through discussion and analysis of the situation. In step C of 191 recipes, 107 prescriptions with antibiotic prescription were analyzed, it was observed that the most prescribed was amoxicillin (37%) and the azithromycin prescription decreased to 14%. The adequacy was 46%, evidencing an improvement of 20%, validated through the chi2 test (p = 0.00). Conclusion: It was observed that through an educational intervention for prescribing professionals, antibiotic prescriptions could be improved, however, it is unknown if the change in prescriptive behavior is maintained over time.


Subject(s)
Humans , Drug Prescriptions , Education , Azithromycin , Knowledge , Dentists , Amoxicillin , Anti-Bacterial Agents
16.
Braz. oral res. (Online) ; 34: e116, 2020. tab, graf
Article in English | LILACS, BBO | ID: biblio-1132690

ABSTRACT

Abstract The exposure to amoxicillin has been associated with molar incisor hypomineralization. This study aimed to determine if amoxicillin disturbs the enamel mineralization in in vivo experiments. Fifteen pregnant rats were randomly assigned into three groups to received daily phosphatase-buffered saline or amoxicillin as either 100 or 500 mg/kg. Mice received treatment from day 13 of pregnancy to day 40 postnatal. After birth, the offsprings from each litter continued to receive the same treatment according to their respective group. Calcium (Ca) and phosphorus (P) content in the dental hard tissues were analyzed from 60 upper first molars and 60 upper incisors by the complexometric titration method and colorimetric analysis using a spectrophotometer at 680 nm, respectively. Lower incisors were analyzed by X-ray microtomography, it was measured the electron density of lingual and buccal enamel, and the enamel and dentin thickness. Differences in Ca and P content and electron density among the groups were analyzed by one-way ANOVA. There was no significant difference on enamel electron density and thickness among the groups (p > 0.05). However, in incisors, the higher dose of amoxicillin decreased markedly the electron density in some rats. There were no statistically significant differences in Ca (p = 0.180) or P content (p = 0.054), although the higher dose of amoxicillin could affect the enamel in some animals. The amoxicillin did not significantly alter the enamel mineralization and thickness in rats.


Subject(s)
Animals , Female , Pregnancy , Mice , Rats , Dental Enamel , Dental Enamel Hypoplasia , Amoxicillin , Incisor , Molar
17.
Arq. gastroenterol ; 56(4): 361-366, Oct.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1055160

ABSTRACT

ABSTRACT BACKGROUND: Helicobacter pylori infection in Chile remains as a public and private health-care system's challenge, with a prevalence of the infection over 70%. Nowadays, antibiotic treatment of the infection is mandatory to prevent the arising of severe associated diseases but failures in the eradication therapy mainly due to clarithromycin resistance has been observed worldwide and first line eradication therapy seems to be not effective anymore in several geographical areas. Thus, health-care systems are committed to maintain an epidemiological surveillance upon the evolution of the antibiotic resistance of this priority 2 pathogen. OBJECTIVE: This work reports a 10 years surveillance of the primary antibiotic resistance of H. pylori clinical isolates at the Biobío region-Chile, and the evolution of resistance toward amoxicillin, clarithromycin, levofloxacin, metronidazole, and tetracycline among the species. METHODS: H. pylori strains were investigated during the periods 2005-2007 (1435 patients analysed) and 2015-2017 (220 patients analysed) by inoculating a saline homogenate biopsy onto the surface of Columbia agar (Oxoid, Basingstoke, UK) - supplemented with 7% horse red blood cells plus DENT inhibitor (Oxoid, Basingstoke, UK) - following by incubation at 37ºC under 10% CO2 atmosphere for five days. Antibiotic resistance pattern of the isolates was assessed using the disk diffusion test in Müeller-Hinton agar supplemented with 7% horse red blood cells followed by incubation for further three days under 10% CO2 atmosphere. Statistical analysis was done using the SPSS v22 software and P values <0.05 were considered statistically significant. RESULTS: A total of 41% of 1435 patients were detected to be infected with H. pylori by bacteriological culture in 2005-2007 period, meanwhile 32.7% from 220 patients were also infected in 2015-2017 period. The clinical isolates of H. pylori are mostly susceptible to amoxicillin and tetracycline (both over 98% of strains), but less susceptible to levofloxacin in both periods analysed (over 79% of the strains). On the other hand, metronidazole continuous showing the highest score of resistant isolates (over 40% of resistant strains), although an 18% fewer resistant strains were observed in 2015-2017 period. Clarithromycin, the key antibiotic in eradication therapies, has an increased frequency of resistant strain isolated in the decade (22.5% in 2005-2007 and 29.2% in 2015-2017). Multidrug resistant strains (two, three and four antibiotics) were also detected in both periods with the highest scores for simultaneous resistance to clarithromycin-metronidazole (18%) and clarithromycin-metronidazole-levofloxacin (12.5%) resistant strains. According to gender, the isolates resistant to amoxicillin, clarithromycin and metronidazole were more frequent in female, with a specific increment in amoxicillin and clarithromycin resistance. CONCLUSION: The frequency of clarithromycin resistance (29.2%) detected in 2015-2017 suggests that conventional triple therapy is no longer effective in this region.


RESUMO CONTEXTO: A infecção por Helicobacter pylori no Chile permanece como um desafio do sistema de saúde público e privado, com prevalência da infecção acima de 70%. Hoje em dia, o tratamento antibiótico da infecção é obrigatório para prevenir o surgimento de graves doenças associadas, mas falhas na terapia de erradicação, principalmente devido à resistência à claritromicina, têm sido observadas em todo o mundo, e a terapia de erradicação de primeira linha parece não ser mais eficaz em várias áreas geográficas. Assim, os sistemas de saúde estão comprometidos em manter uma vigilância epidemiológica sobre a evolução da resistência aos antibióticos deste patógeno prioritário tipo 2. OBJETIVO: Este trabalho relata uma vigilância de 10 anos da resistência antibiótica primária de isolados clínicos de H. pylori na região do Biobío-Chile, e a evolução da resistência em relação à amoxicilina, claritromicina, levofloxacina, metronidazol e tetraciclina entre as espécies. MÉTODOS: As cepas de H. pylori foram investigadas durante os períodos 2005-2007 (1435 pacientes analisados) e 2015-2017 (220 pacientes analisados) inoculando uma biópsia de homogeneizado fisiológico na superfície do agar Columbia (Oxoid, Basingstoke, Reino Unido) - suplementado com 7% de glóbulos vermelhos do cavalo mais o inibidor de DENTE (Oxoid, Basingstoke, Reino Unido) - seguindo pela incubação em 37ºC a atmosfera de 10% de CO2 por cinco dias. O padrão de resistência aos antibióticos dos isolados foi avaliado utilizando-se o teste de difusão em disco em agar Müeller-Hinton suplementado com 7% de glóbulos vermelhos de cavalo seguidos de incubação por mais três dias a atmosfera de 10% de CO2. A análise estatística foi realizada utilizando-se o software SPSS V22 e os valores de P<0,5 foram considerados estatisticamente significantes. RESULTADOS: Um total de 41% dos 1435 pacientes foram detectados como contaminados por H. pylori pela cultura bacteriológica no período 2005-2007, ao mesmo tempo 32,7% de 220 pacientes foram contaminados igualmente no período 2015-2017. Os isolados clínicos de H. pylori são principalmente suscetíveis à amoxicilina e tetraciclina (tanto mais de 98% das cepas), mas menos suscetíveis à levofloxacina em ambos os períodos analisados (mais de 79% das cepas). Por outro lado, o metronidazol permaneceu mostrando a maior pontuação de resistentes isolados (mais de 40% de cepas resistentes), embora tenham sido observados 18% menos cepas resistentes no período de 2015-2017. A claritromicina, o antibiótico-chave em terapias de erradicação, tem uma frequência aumentada de cepa resistente isolada na década (22,5% em 2005-2007 e 29,2% em 2015-2017). Cepas multirresistentes (dois, três e quatro antibióticos) também foram detectadas em ambos os períodos com os maiores escores de resistência simultânea à claritromicina-metronidazol (18%) e claritromicina-metronidazol-levofloxacina (12,5%) cepas resistentes. De acordo com o sexo, os isolados resistentes à amoxicilina, claritromicina e metronidazol foram mais frequentes no sexo feminino, com incremento específico em amoxicilina e resistência à claritromicina. CONCLUSÃO: A frequência de resistência à claritromicina (29,2%) detectada em 2015-2017 sugere que a terapia tripla convencional não é mais efetiva nesta região.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Helicobacter pylori/drug effects , Anti-Bacterial Agents/pharmacology , Tetracycline/pharmacology , Population Surveillance , Helicobacter Infections/microbiology , Clarithromycin/pharmacology , Drug Resistance, Multiple, Bacterial , Disk Diffusion Antimicrobial Tests , Levofloxacin , Amoxicillin/pharmacology , Metronidazole/pharmacology , Middle Aged
18.
Rev. medica electron ; 41(3): 641-654, mayo.-jun. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1094073

ABSTRACT

RESUMEN Introducción: la toxicidad de los fármacos es compleja y difícilmente valorable, por la cantidad de factores que intervienen en su producción, como modo de aparición, duración y gravedad de las reacciones adversas. La importancia de estas reacciones está dada por la frecuencia y gravedad con que un fármaco o familia de fármacos las producen. Objetivo: caracterizar las principales reacciones adversas que provocan los medicamentos, los grupos de edades con más riesgos, los sistemas de órganos que se afectan, la frecuencia, imputabilidad y la intensidad de las mismas. Materiales y métodos: estudio observacional, descriptivo, de serie de casos en farmacovigilancia. El universo fue las reacciones adversas de los 10 fármacos más notificados por la Unidad Coordinadora Provincial de Farmacovigilancia en Matanzas, en el periodo 2014-2017. Se estudiaron las variables: medicamentos, grupo farmacológico, datos demográficos, nivel de atención, tipo de efecto adverso, intensidad, imputabilidad y frecuencia. Resultados: se notificaron 10 fármacos con 2 216 reacciones. La vacuna pentavalente fue la más notificada, con un 17,6 %, seguido por la amoxicilina y las penicilinas. Predominó el sexo femenino con 1 279 reportes, (59,1 %) y los adultos, con 1 010 notificaciones, (46,6 %). La atención primaria de salud fue la de mayor número de notificaciones, 2 082 reportes, (96,1 %). Las principales reacciones fueron: la erupción cutánea, la fiebre y la urticaria. Predominaron reacciones moderadas; 1 972 reportes, (91,1 %), aquellas clasificadas como probables, 1 887 reportes, (87,1 %) y las frecuentes con 1 284 reportes, (59,2 %). Conclusiones: el sistema de farmacovigilancia en la provincia proporcionó sistemáticamente información sobre la seguridad de los medicamentos, lo que permitió el conocimiento de la relación beneficio-riesgo de los medicamentos presentes en el mercado, así como los más usados.


ABSTRACT Introduction: drugs toxicity is complex and of difficult assessment, due to the quantity of factors intervening in its production, like emergency way, duration, and seriousness of the adverse reactions. The importance of these reactions is given by the frequency and seriousness a drug or a drug family produces them. Objective: to characterize the main adverse reactions caused by medicines, the age groups having higher risk, the most affec6ted systems of organs, frequency, imputability and intensity. Material and methods: descriptive, observational study of a series of cases in pharmacovigilance. The universe was the adverse reactions of the ten drugs most reported by the Provincial Coordinating Unit of Pharmacovigilance in the period 2014-2017. The studied variables were: drugs, pharmacological group, demographic data, health care level, kind of adverse effect, intensity, imputability and frequency. Results: ten drugs were reported with 2 216 reactions. The pentavalent vaccine was the most reported one, with 17.6 %, followed by amoxicillin and penicillin. There was a predominance of the female sex with 1 279 reports (59.1 %), and adult people with 1 010 reports (46.6 %). The highest number of reports was made by the primary health care, 2 082 (96.1 %). The main reactions were skin rash, fever and urticaria. There was a predominance of mild reactions: 1 972 reports (91.1 %); reactions classified as probable: 1 887 reports (87.1 %): ands frequent ones: 1 284 reports (59.2 %). Conclusions: the pharmacovigilance system in the province systematically provided information on drugs´ safeness that allowed knowing the benefit-risk relation of the medicines that are in the market, and also which are the most used ones.


Subject(s)
Humans , Female , Adult , Penicillins/adverse effects , Risk Assessment , Drug-Related Side Effects and Adverse Reactions , Organs at Risk , Pharmacovigilance , Amoxicillin/adverse effects , Urticaria/diagnosis , Epidemiology, Descriptive , Exanthema Subitum/diagnosis , Fever/diagnosis , Observational Study
19.
Biomédica (Bogotá) ; 39(supl.1): 125-134, mayo 2019. tab
Article in Spanish | LILACS | ID: biblio-1011461

ABSTRACT

Resumen Introducción. La resistencia a los antibióticos es la principal causa del fracaso del tratamiento contra Helicobacter pylori; la claritromicina y el metronidazol son los antibióticos que generan mayor resistencia. En Colombia, la resistencia primaria a estos dos antibióticos y el uso excesivo de levofloxacina han alcanzado los límites aceptados (13,6, 83 y 16 %, respectivamente). A pesar de ello, se usa el tratamiento empírico combinando estos antibióticos en pacientes en los que ha fallado anteriormente. Objetivo. Determinar la resistencia a los antibióticos en pacientes previamente tratados para H. pylori en Bogotá, Colombia. Materiales y métodos. Se llevó a cabo un estudio descriptivo en el que se evaluó mediante dilución en agar la resistencia a la amoxicilina, la claritromicina, la levofloxacina y el metronidazol en 10 aislamientos provenientes de 5 pacientes con tres o cuatro tratamientos fallidos para H. pylori. La resistencia a los antibióticos se confirmó mediante secuenciación de ADN (Magrogen, Korea). Resultados. Ocho de los aislamientos presentaron resistencia a dos o más antibióticos y todos fueron resistentes a la levofloxacina. Los patrones de sensibilidad de los aislamientos provenientes del antro pilórico y del cuerpo del estómago, fueron diferentes en tres de los pacientes. Conclusión. Hasta donde se sabe, esta es la primera evidencia de resistencia múltiple de H. pylori en Colombia en pacientes previamente tratados. Los resultados evidenciaron las consecuencias del uso de un esquema ineficaz de tratamiento antibiótico y la necesidad de evaluar la sensibilidad a los antibióticos en diferentes sitios anatómicos del estómago. La resistencia múltiple limita el número de antibióticos útiles para erradicar H. pylori.


Abstract Introduction: The main cause for Helicobacter pylori infection treatment failure is antibiotic resistance, where clarithromycin and metronidazole play the main role. In Colombia, primary resistance as a consequence of the use of these two antibiotics and excessive levofloxacin use is above the accepted limit (13.6%, 83%, and 16%, respectively). Despite this fact, empirical therapies that include the combination of these antibiotics are used in patients with previous therapeutic failure. Objective: To determine antibiotic resistance in patients previously treated for H. pylori in Bogotá, Colombia. Materials and methods: We conducted a descriptive study that included ten isolates obtained from five patients with three or four previous failed treatments for H. pylori. Antibiotic resistance to amoxicillin, clarithromycin, levofloxacin, and metronidazole was investigated by agar dilution and confirmed by DNA sequencing (Magrogen, Korea). Results: Eight isolates were resistant to two or more antibiotics. All isolates were resistant to levofloxacin. Susceptibility patterns in isolates from the gastric antrum and the body of the stomach were different in three patients. Conclusion: As far as we know, this is the first evidence of multiple H. pylori resistance in Colombia in previously treated patients. Results demonstrated the consequences of using an ineffective antibiotic scheme and the need to assess antibiotic susceptibility in different anatomical sites of the stomach. The consequences of multiple resistance decrease possible antibiotic effectiveness to eradicate H. pylori in the future.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Helicobacter pylori/drug effects , Helicobacter Infections/microbiology , Drug Resistance, Multiple, Bacterial , Gastritis/microbiology , Biopsy , DNA, Bacterial/genetics , Microbial Sensitivity Tests , Helicobacter pylori/isolation & purification , Helicobacter pylori/genetics , Helicobacter Infections/epidemiology , Gastroscopy , Clarithromycin/therapeutic use , Clarithromycin/pharmacology , Colombia/epidemiology , Drug Resistance, Multiple, Bacterial/genetics , Levofloxacin/therapeutic use , Levofloxacin/pharmacology , Gastritis/epidemiology , Genes, Bacterial , Amoxicillin/pharmacology , Metronidazole/therapeutic use , Metronidazole/pharmacology , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/pharmacology
20.
Arq. Ciênc. Vet. Zool. UNIPAR (Online) ; 22(3): 91-92, jul-set. 2019.
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1052672

ABSTRACT

Atualmente, o uso indiscriminado de antimicrobianos tem contribuído para o aparecimento de microrganismos resistentes, pois, os mesmos ao entrarem em contato com o princípio ativo dessas drogas de forma indevida, desenvolvem características fisiológicas e genéticas tais como a mutação de seu DNA, podendo passar esses genes de resistência à sua descendência por meio de replicação ou por conjugação de plasmídeos, fazendo com que se reduzam as opções de tratamentos efetivos para as infecções bacterianas, aumentando assim as complicações clínicas de pacientes, sejam eles o homem ou os animais de companhia e/ou produção. Recentemente o nosso grupo de pesquisa realizou um estudo com proprietários de cães do curso de Medicina Veterinária e resultados prévios demonstraram alto perfil de resistência aos antimicrobianos da classe das penicilinas, sendo a amoxicilina o antimicrobiano que apresentou menor eficácia, dentre os antimicrobianos testados para aquela classe. Um dos principais fatores relacionados ao aparecimento de resistência está relacionado ao seu uso excessivo e segundo avaliação prévia dos questionários dos tutores verificou-se um predomínio do uso desse antimicrobiano, tanto pelos tutores quanto para tratamento dos animais. Além disso, a falta de informação dos pacientes e o comportamento dos mesmos em relação aos seus animais de companhia levam-os a utilizarem doses insuficientes dos antimicrobianos quando os mesmos suspendem seu uso quando o animal apresenta melhora clínica. Cabe salientar ainda, a existência de resistência intrínseca do micro-organismo à antimicrobianos específicos, demonstrando a necessidade do isolamento e identificação do micro-organismo e realização da antibiograma para escolha mais adequada do antimicrobiano a ser prescrito. Conclui-se que os proprietários de cães podem compartilhar do mesmo perfil de resistência aos antimicrobianos que seus cães, demonstrando a necessidade da orientação dos mesmos para se reduzir o índice de resistência aos antimicrobianos.(AU)


The indiscriminate use of antimicrobials in recent times has contributed to the emergence of resistant microorganisms by improperly coming into contact with the active principle of such drugs and developing physiological and genetic characteristics such as DNA mutation. These resistant genes can be passed along to their offspring by replication or plasmid conjugation, reducing the options of effective treatments for bacterial infections, thus increasing the clinical complications of patients, whether humans or pets and/or livestock. Recently, the authors held a study with dog owners from the Veterinary Medicine course and the initial results showed a high profile of resistance to antimicrobials belonging to the penicillin class, with amoxicillin being the least effective antimicrobial among the ones tested for the class. One of the main factors related to the appearance of resistance is related to its excessive use, and according to previous assessment of the tutors' questionnaires, there was a predominance of the use of this antimicrobial both by the tutors and for the treatment of their animals. In addition, the patients' lack of information and their behavior regarding their pets lead them to use insufficient doses of antimicrobials, since they discontinued its use when the animal presented signs of clinical improvement. It is also important to note the existence of microorganism intrinsic resistance to specific antimicrobials, demonstrating the necessity of isolation and identification of the microorganism, as well as carrying out an antibiogram for the most appropriate choice of antimicrobial to be prescribed. It can be concluded that dog owners can share the same antimicrobial resistance profile as their dogs, demonstrating the need for guidance in order to reduce the antimicrobial resistance index.(AU)


Actualmente, el uso indiscriminado de antimicrobianos ha contribuido a la aparición de microorganismos resistentes, ya que entran en contacto de manera inadecuada con el principio activo de estos fármacos, desarrollan características fisiológicas y genéticas como la mutación de su ADN, pudiendo transmitir esos genes de resistencia a su descendencia por replicación o conjugación de plásmidos, haciendo con que reduzcan las opciones de tratamientos efectivos para las infecciones bacterianas, aumentando así las complicaciones clínicas de los pacientes, sean humanos o mascotas y/o producción. Recientemente, nuestro grupo de investigación realizó un estudio con dueños de perros del curso de Medicina Veterinaria y los resultados anteriores mostraron un alto perfil de resistencia a los antimicrobianos de la clase de las penicilinas, siendo la amoxicilina el antimicrobiano menos efectivo entre los antimicrobianos probados para esa clase. Uno de los principales factores relacionados con la aparición de resistencia está relacionado a su uso excesivo y, según la evaluación previa de los cuestionarios de los tutores se verificó un predominio del uso de ese antimicrobiano, tanto por parte de los tutores como para el tratamiento de los animales. Además, la falta de información de los pacientes y el comportamiento de los mismos con respecto a sus mascotas los llevan a usar dosis insuficientes de antimicrobianos cuando el animal muestra una mejoría clínica. Todavía cabe mencionar la existencia de resistencia intrínseca del microorganismo a antimicrobianos específicos, lo que demuestra la necesidad de aislamiento e identificación del microorganismo y la realización de antibiograma para la elección más adecuada de antimicrobianos a recetar. Se puede concluir que los dueños de perros pueden compartir del mismo perfil de resistencia a los antimicrobianos que sus perros, lo que demuestra la necesidad de su orientación para reducir el índice de resistencia a los antimicrobianos.(AU)


Subject(s)
Animals , Dogs , Dogs/microbiology , Amoxicillin , Anti-Bacterial Agents/chemical synthesis
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