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1.
Arq. bras. med. vet. zootec. (Online) ; 73(1): 91-98, Jan.-Feb. 2021. tab
Article in English | LILACS, VETINDEX | ID: biblio-1153050

ABSTRACT

The metabolic peculiarities of felines favor an intoxication. Fifty healthy female cats were divided into five groups: PG (placebo group), G2 (cefazolin), G3 (ceftriaxone), G4 (enrofloxacin) and G5 (ampicillin) were used. The parameters evaluated were: total expired carbon dioxide (ETCO2), oxygen saturation in hemoglobin (SpO2), heart rate (HR), respiratory rate (RR), body temperature (BT), systolic, mean and diastolic blood pressure (SBP, mBP and DBP) by invasive method, at T0, 5 (T5), 10 (T10), 15 (T15), 20 (T20), 25 (T25) and 30 (T30) minutes after administration of the treatments. HR presented reduction in G2 compared to PG at all times, except T20, and in G4, T25 and T30 were lower than the T0 values (P<0.05). BT showed increase in the G3 at T0 and T5 and all groups showed reduction in the values of BT relative to T0 (P<0.05). ETCO2 increased in G2 and G5 at all times compared to PG (P<0.05) and there were no differences among the times within each group. It was concluded that ceftriaxone is safer for the prophylactic antimicrobial use in cats, however the other antimicrobials are also indicated, because all the parameters, in all groups, basically did not change over the study and when this occurs it remains in reference interval.(AU)


As peculiaridades metabólicas dos felinos favorecem quadro de intoxicação. Foram utilizadas 50 gatas saudáveis, que foram divididas em cinco grupos: GP (grupo placebo), G2 (grupo cefazolina), G3 (grupo ceftriaxona), G4 (grupo enrofloxacina) e G5 (grupo ampicilina). Os seguintes parâmetros foram avaliados: dióxido de carbono expirado (ETCO2), saturação de oxigênio na hemoglobina (SpO2), frequência cardíaca (FC), frequência respiratória (FR), temperatura corporal (T°C), pressão arterial sistólica,média e diastólica (PAS, PAM e PAD), pelo método invasivo, em 0 (T0), 5 (T5), 10 (T10), 15 (T15), 20 (T20), 25 (T25) e 30 (T30) minutos após a administração dos tratamentos. A FC apresentou redução no G2 em relação ao GP em todos os momentos, exceto no T20, e, no G4, o T25 e o T30 foram inferiores aos valores do T0 (P<0,05). A T°C apresentou aumento no G3 no T0 e no T5, e todos os grupos apresentaram redução nos valores da T°C em relação ao T0 (P<0,05). O ETCO2 apresentou aumento no G2 e no G5, em todos os momentos, em relação ao GP (P<0,05). Concluiu-se que a ceftriaxona é mais segura para uso profilático em gatos, entretanto os outros antibióticos também são recomendados, pois todos os parâmetros praticamente não se modificaram e, quando alterados, mantiveram-se dentro dos padrões de referência.(AU)


Subject(s)
Animals , Cats , Ceftriaxone/administration & dosage , Respiratory Rate/drug effects , Heart Rate/drug effects , Anti-Infective Agents/administration & dosage , Anti-Infective Agents/adverse effects , Hemodynamics , Anesthesia, Intravenous/veterinary
2.
Braz. J. Vet. Res. Anim. Sci. (Online) ; 57(2): e166204, mai. 2020. ilus, graf
Article in English | LILACS, VETINDEX | ID: biblio-1122176

ABSTRACT

Medical management of abdominal abscesses in horses requires prolonged antibiotic therapy and presents varied success rates. A 6-year-old male horse with a history of colic and multiple abdominal punctures to relieve gas was attended. At admission, tachycardia, tachypnea, hyperthermia, mucosal congestion, dehydration, and rigid gait were observed. The association of physical examination, laboratory and ultrasonographic findings allowed the diagnoses of peritonitis and abdominal abscess. Supporting treatment plus broad spectrum antibiotic therapy was performed: daily intraperitoneal ceftriaxone (25 mg/kg, 7 days); daily intravenous gentamicin (6.6 mg/kg, 7 days); per os metronidazole three times a day (15 mg/kg 12 days), followed by the same dose twice a day (15 mg/kg 33 days), totaling 45 days of treatment. Plasma fibrinogen and ultrasonographic examination were the most effective tools to evaluate abscess evolution. There was normalization of the physical examination 24 h after beginning the treatment, consecutive regression of the nucleated cell count in the peritoneal fluid, and regression of plasma fibrinogen and size of the abscess. On the 10th treatment day, the animal was discharged from the hospital, maintaining oral therapy with metronidazole every 12 h (15 mg / kg). When the animal returned on the 30th day, an abscess size regression was observed. However, there was no resolution, and therapy with metronidazole was maintained. On the 45th day of treatment, a new hospital evaluation was performed, where the abscess resolved, and metronidazole was suspended. It is highlighted that the therapeutic association used in the treatment of abdominal infection and abscess resulted in a rapid clinical response.(AU)


O tratamento conservativo dos abscessos abdominais em equinos requer antibioticoterapia prolongada e apresenta variadas taxas de sucesso. Foi atendido um cavalo de seis anos de idade, com histórico de cólica e múltiplas punções abdominais por agulha para esvaziamento de gás. Na admissão, foram observados taquicardia, taquipnéia, hipertermia, congestão mucosa, desidratação e marcha rígida. A associação do exame físico, achados laboratoriais e ultrassonográficos permitiu o diagnóstico de peritonite e abscesso abdominal. Foi realizado tratamento suporte e antibioticoterapia de amplo espectro: ceftriaxona intraperitoneal diária (25 mg/kg, 7 dias); gentamicina intravenosa diária (6,6 mg/kg, 7 dias); metronidazol oral três vezes ao dia (15 mg/kg, 12 dias), seguido de mesma dose duas vezes ao dia, por mais 33 dias, totalizando 45 dias de tratamento. O fibrinogênio plasmático e o exame ultrassonográfico foram os recursos mais eficazes para a avaliação da evolução do abscesso. Após 24 horas do início do tratamento foi constatada a normalização do exame fisico, regressão progressiva da contagem de células nucleadas no líquido peritoneal, do fibrinogênio plasmático e do tamanho do abscesso. No 10° dia de tratamento o animal recebeu alta hospitalar, mantendo-se a terapia oral com metronidazol a cada 12 horas (15 mg/Kg). Em retorno, ao 30° dia, observou-se regressão do tamanho do abscesso, entretanto, não houve resolução, tendo sido mantida a terapia com metronidazol. No 45º dia de tratamento, realizou-se nova avaliação hospitalar, onde foi observada a resolução do abscesso e a admnistração do metronidazol foi suspensa. Destaca-se, que a associação terapêutica utilizada no tratamento de infecção abdominal e abscesso resultou em rápida resposta clínica.(AU)


Subject(s)
Animals , Peritonitis/veterinary , Ceftriaxone/administration & dosage , Gentamicins/administration & dosage , Abdominal Abscess/veterinary , Horses , Metronidazole/administration & dosage , Ultrasonics , Fibrinogen , Injections, Intraperitoneal/veterinary
3.
Rev. chil. infectol ; 36(3): 253-264, jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1013782

ABSTRACT

Resumen Introduccion: Actualmente cerca de la mitad de las prescripciones de antimicrobianos son inadecuadas, lo que aumenta la resistencia bacteriana. Tanto cefalosporinas como fluoroquinolonas se asocian con este fenomeno: aumento de bacterias productoras de β-lactamasas e infecciones por Clostridioides difficile, por lo que las agencias reguladoras buscan racionalizar su uso. Objetivo: Evaluar el efecto de recomendaciones para el uso adecuado de antimicrobianos en la proporcion de prescripciones inadecuadas de ceftriaxona y fluoroquinolonas. Metodologia: Se desarrollo un estudio de antes y despues, prospectivo e intervencional, que comparo la calidad y la cantidad de uso de ceftriaxona y fluoroquinolonas antes y despues de la implementacion de recomendaciones de uso para tratamientos de enfermedades infecciosas adquiridas en la comunidad. Los parametros medidos fueron: proporcion de prescripciones inadecuadas y DDD. Los datos se analizaron por medio del test de χ2, correccion de Fisher y test de Student. Resultados: Se evaluaron 206 pacientes, observandose una disminucion de 35% en las prescripciones inadecuadas, una reduccion del consumo de ceftriaxona y levofloxacina y un aumento significativo de la utilizacion de ampicilina/sulbactam. Conclusiones: La implementacion de recomendaciones de uso basadas en evidencia cientifica y susceptibilidad local, permitieron disminuir la proporcion de prescripciones inadecuadas y reducir el consumo de ceftriaxona y fluoroquinolonas.


Background: Nowadays about half of antibiotic prescriptions are inadequate, increasing bacterial resistance. Both cephalosporins and fluoroquinolones are associated with this phenomenon: increase of β-lactamase producing bacteria and Clostridioides difficile infections, which is why regulatory agencies seek to rationalize their use. Aim: To evaluate the effect of use recommendations on the proportion of inadequate prescriptions of ceftriaxone and fluoroquinolones. Methods: A prospective and interventional study was developed, comparing the quality and quantity of use of ceftriaxone and fluoroquinolones before and after the implementation of use recommendations for treatments of infectious diseases acquired at the community. The outcomes were: proportion of inadequate prescriptions and defined daily dose (DDD). Data were analyzed using the Chi-square test, Fisher's correction and Student's test. Results: A total of 206 patients were evaluated, a 35% decrease in inadequate prescriptions, a decline in the consumption of ceftriaxone and levofloxacin, and a significant increase in the use of ampicillin/ sulbactam was observed. Conclusions: The implementation of use recommendations based on scientific evidence and local susceptibility allowed to reduce the proportion of inadequate prescriptions and to reduce de consumption of ceftriaxone and fluoroquinolones.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Drug Prescriptions/standards , Ceftriaxone/administration & dosage , Fluoroquinolones/administration & dosage , Antimicrobial Stewardship/standards , Hospitals, University/standards , Anti-Bacterial Agents/administration & dosage , Drug Administration Schedule , Prospective Studies , Treatment Outcome , Drug Utilization/standards , Inappropriate Prescribing/statistics & numerical data , Hospitalization/statistics & numerical data , Length of Stay
4.
Rev. bras. oftalmol ; 78(2): 133-136, mar.-abr. 2019.
Article in Portuguese | LILACS | ID: biblio-1003576

ABSTRACT

Resumo A doença de Lyme é uma infecção sistêmica causada pela espiroqueta Borrelia burgdorferi e transmitida pelo carrapato do gênero Ixodes sp. e espécie Amblyomma cajennense. A doença costuma se manifestar em três estágios clínicos distintos, que podem variar de acordo com as características de cada hospedeiro. O objetivo deste trabalho é relatar o caso de uma paciente de 33 anos com doença de Lyme que apresentou como manifestações neuroftalmológicas diplopia, lagoftalmo paralítico e ceratite punctata, com exames laboratoriais negativos. Embora a espiroqueta Borrelia burgdorferi tenha maior tropismo pelos tecidos da pele, sistema nervoso e articulações, o acometimento ocular não deve ter sua importância diminuída, sendo descrito neste relato de caso, que abordou os aspectos mais pertinentes à doença para auxiliar seu diagnóstico e tratamento.


Abstract Lyme disease is a systemic infection caused by the spirochete Borrelia burgdorferi and transmitted by the tick of the genus Ixodes sp. and species Amblyomma cajennense. The disease usually manifests itself in three distinct clinical stages, which may vary according to the characteristics of each host. The objective of this paper is to report the case of a 33-year-old patient with Lyme disease who presented as neuro-ophthalmological manifestations diplopia, paralytic lagophthalmos and punctate keratitis, with negative laboratory tests. Although the spirochete Borrelia burgdorferi has a greater tropism in the tissues of the skin, nervous system and joints, the ocular involvement should not be diminished, being described in this case report, which approached the most pertinent aspects to the disease to aid its diagnosis and treatment.


Subject(s)
Humans , Female , Adult , Lyme Disease/complications , Diplopia/etiology , Eye Diseases/etiology , Facial Paralysis/etiology , Borrelia Infections/transmission , Ceftriaxone/administration & dosage , Lyme Disease/diagnosis , Lyme Disease/drug therapy , Borrelia burgdorferi Group/isolation & purification , Ixodes , Lyme Neuroborreliosis/complications , Amblyomma , Nervous System Diseases/etiology
5.
Rev. bras. ginecol. obstet ; 41(2): 90-96, Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-1003534

ABSTRACT

Abstract Objective: The present study assessed epidemiological and obstetrical data from pregnant women with syphilis at the Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro (UFTM, in the Portuguese acronym), describing this disease during pregnancy and its vertical transmission for future healthcare actions. Methods: Records from pregnant women who had been admitted to the Obstetrics Department of the Hospital de Clínicas of the UFTM and were diagnosed with syphilis between 2007 and 2016 were reviewed. A standardized form was used to collect epidemiological, obstetric data and outcomes of congenital infection. The present research has been authorized by the Ethics Committee of the institution. Results: There were 268 women diagnosed with syphilis, with an average age of 23.6 years old. The majority of the patients were from Uberaba. Inadequate prenatal care was observed in 37.9% of the pregnant women. Only 34.2% of the patients completed the treatment according to the guidelines issued by the Ministry of Health of Brazil, and 19.8% of the partners of the patients underwent adequate syphilis treatment; 37 (13.8%) couples (patients and partners) underwent correct treatment. Regarding the obstetric outcomes, 4 (1.5%) patients had a miscarriage and 8 (3.4%) had fetal losses (from the fetal loss group, 7 had no adequate treatment); 61 (25.9%) patients had premature births - this prematurity has been significantly correlated to inadequate or incomplete treatment in 49 (27.9%) patients, compared with 12 (13.0%) patients with premature births and adequate treatment (p = 0.006). The average live newborn weight was 2,840 g; 25.3% had a birth weight < 2,500 g; 74.2% had congenital syphilis, a data with heavy correlation to inadequate or incomplete prenatal care, prematurity, and low birth weight. Conclusion: Public awareness policies on adequate prenatal care, intensification of serological screening, and early treatment of syphilis are needed, considering the rise of cases diagnosed during gestation and its potentially preventable deleterious consequences related to congenital transmission.


Resumo Objetivo: O presente estudo avaliou dados epidemiológicos e obstétricos de gestantes com sífilis no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro (UFTM), objetivando o conhecimento desta infecção no ciclo gravídico e a transmissão vertical para futuras ações em saúde pública. Métodos: Foram revisados registros de gestantes admitidas no Departamento de Ginecologia e Obstetrícia do Hospital de Clínicas da UFTM, diagnosticadas com sífilis entre 2007 e 2016. Para a coleta de dados, utilizou-se um formulário padronizado enfocando aspectos epidemiológicos, obstétricos e infecção congênita. A presente pesquisa foi autorizada pelo Comitê de Ética da instituição. Resultados: Obteve-se 268 gestantes diagnosticadas com sífilis, com idade media de 23,6 anos, sendo a maioria de Uberaba. A assistência pré-natal foi inadequada em 37,9% dos casos. O tratamento para sífilis, de acordo com as diretrizes do Ministério da Saúde do Brasil, foi realizado por 34,2% das gestantes e por 19,8% dos parceiros. Quanto aos desfechos obstétricos, observou-se que 4 (1,5%) pacientes evoluíram com abortamento e 8 (3,4%) com óbito fetal, das quais 7 não realizaram tratamento. Observou-se parto prematuro em 61 (25,9%) gestantes, e a prematuridade foi significativamente associada ao tratamento ausente/incompleto, com 49 (27,9%) casos, comparada a 12 (13,0%) casos nos quais o tratamento foi adequado (p = 0,006). Quanto aos recém-nascidos, o peso médio foi de 2.840 g, e 25,3% apresentaram peso < 2.500 g. Diagnosticou-se infecção congênita em 74,2%, dos casos, associada significativamente ao pré-natal inadequado, ao tratamento ausente/ incompleto, à prematuridade e ao baixo peso ao nascer. Conclusão: Políticas públicas de conscientização sobre pré-natal adequado, intensificação de rastreamento sorológico e tratamento precoce da sífilis são necessárias, haja vista a ascensão dos casos diagnosticados na gestação e suas consequências deletérias potencialmente evitáveis relacionadas à transmissão congênita.


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Young Adult , Pregnancy Complications, Infectious/epidemiology , Syphilis/epidemiology , Penicillin G Benzathine/administration & dosage , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/drug therapy , Prenatal Diagnosis , Prognosis , Syphilis, Congenital/drug therapy , Syphilis, Congenital/epidemiology , Ceftriaxone/administration & dosage , Brazil/epidemiology , Drug Administration Schedule , Syphilis/diagnosis , Syphilis/drug therapy , Retrospective Studies , Treatment Outcome , Hospitalization/statistics & numerical data , Hospitals, Public/statistics & numerical data , Anti-Bacterial Agents/administration & dosage
6.
Acta cir. bras ; 32(12): 995-1005, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-886196

ABSTRACT

Abstract Purpose: To evaluate the actual incidence of both microlithiasis and acute cholecystitis during treatment with intravenous ceftriaxone in a new rabbit model. Methods: New Zealand rabbits were treated with intravenous ceftriaxone or saline for 21 days. Ultrasound monitoring of the gallbladder was performed every seven days until the 21st day when histopathology, immunohistochemistry for proliferating cell nuclear antigen (PCNA), pro-caspase-3 and CD68, liver enzyme biochemistry, and chromatography analysis of the bile and sediments were also performed. Results: All animals treated with ceftriaxone developed acute cholecystitis, confirmed by histopathology (P<0.05) and biliary microlithiasis, except one that exhibited sediment precipitation. In the group treated with ceftriaxone there was an increase in pro-caspase-3, gamma-glutamyl transpeptidase concentration, PCNA expression and in the number of cells positive for anti-CD68 (P<0.05). In the ceftriaxone group, the cholesterol and lecithin concentrations increased in the bile and a high concentration of ceftriaxone was found in the microlithiasis. Conclusion: Ceftriaxone administered intravenously at therapeutic doses causes a high predisposition for lithogenic bile formation and the development of acute lithiasic cholecystitis.


Subject(s)
Animals , Rats , Ceftriaxone/adverse effects , Cholecystectomy , Cholelithiasis/chemically induced , Cholecystitis, Acute/chemically induced , Anti-Bacterial Agents/adverse effects , Ceftriaxone/administration & dosage , Cholelithiasis/metabolism , Cholecystectomy, Laparoscopic , Cholecystitis, Acute/metabolism , Disease Models, Animal , Translational Medical Research , Administration, Intravenous , Gallbladder/pathology , Anti-Bacterial Agents/administration & dosage
7.
Braz. j. infect. dis ; 21(4): 408-417, July-Aug. 2017. tab
Article in English | LILACS | ID: biblio-888893

ABSTRACT

Abstract Objective: In India, Elores (CSE-1034: ceftriaxone + sulbactam + disodium edetate) was approved as a broad spectrum antibiotic in year 2011 and is used for management of Extended Spectrum Beta Lactamases/Metallo Beta lactamases infections in tertiary care centers. The objective of this study was to investigate the efficacy of this drug in patients with Extended Spectrum Beta Lactamases/Metallo Beta lactamases infections and identify the incidence of adverse events in real clinical settings. Methods: This Post Marketing Surveillance study was conducted at 17 centers across India and included 2500 patients of all age groups suffering from various bacterial infections and treated with Elores (CSE1034). Information regarding demographic, clinical and microbiological parameters, dosage and treatment duration, efficacy and adverse events (AEs) associated with the treatment were recorded. Results: A total of 2500 patients were included in the study and efficacy was evaluated in 2487 patients. In total, 409 AEs were reported in 211 (8.4%) patients. The major AEs reported were vomiting (3.0%), pain at injection site (2.5%), nausea (2.3%), redness at site (1.96%), thrombophlebitis (1.4%). Of total reported AEs, 40 (5.3%) AEs were reported in pediatric, 310 (20.6%) in adult, and 59 (23.6%) in geriatric group. No AE belonging to grade IV or V was reported in any patient. In terms of efficacy, 1977 (79.4%) patients were cured, 501 (20.1%) patients showed clinical improvement and 5 (0.2%) patients were complete failure. The treatment duration varied from 5 to 7 days in different patients depending on the infection type. Conclusion: In this post-marketing surveillance study, CSE-1034 was found to be an effective and safe option against Pip tazo and meropenem in management of patients with multi-drug resistant (MDR) bacterial infections under routine ward settings.


Subject(s)
Humans , Child , Adult , Aged , Gram-Positive Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Ceftriaxone/administration & dosage , Ceftriaxone/adverse effects , Sulbactam/administration & dosage , Sulbactam/adverse effects , Gram-Positive Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/drug therapy , Edetic Acid/administration & dosage , Edetic Acid/adverse effects , Drug Resistance, Bacterial , Drug Combinations , Disk Diffusion Antimicrobial Tests , Gram-Negative Bacteria/classification , Gram-Positive Bacteria/classification , India , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/chemistry
8.
Actual. osteol ; 13(1): 46-57, Ene - Abr. 2017. ilus, graf, tab
Article in English | LILACS | ID: biblio-1118908

ABSTRACT

Based on the hypothesis that fluoride acts as a bone anabolic agent, the aim of this study was to measure in rats the osseointegration of implants (grade II titanium wire, 1 mm diameter, 4 mm long) submitted to anodic oxidation in 2 M phosphoric acid solution (control implants) or b) in 2 M phosphoric acid solution plus 0.2 M NaF (F-modified implants). Chemical composition of the implants surface was assessed by energy-dispersive X-ray spectroscopy. The surface of F-modified implants contained a 2.57% fluorine in weight. Adult male Sprague Dawley rats (300-350 g body weight) received two implants (in the femur and in the tibia, close to the knee) in each hind limb. Control and F-modified implants were inserted in the left and right hind limbs, respectively. Three weeks after surgery, the animals were sacrificed. The undecalcified bones were embedded in methylmetacrylate. Sections were obtained to measure two histomorphometric magnitudes: bone-toimplant contact (BIC) and bone volume in a defined volume of tissue around the implant (BV/TV). BIC was significantly increased on F-modified implants with respect to their controls (57.2%±3.3%, vs. 47.9±3.4, p<0.05). BV/TV did not differ significantly between F-modified and control implants (24.5±2.2% vs. 22.9±1.4, p=0.30). Profiles of the average gray pixel levels of pseudo3D images showed a greater roughness of F-modified implants respect to their controls (p<0.05). The relative contributions of surface roughness and its fluorine content to the osseointegration process requires further research. (AU)


Con la hipótesis de que el ión fluoruro actúa como anabólico sobre las células óseas, el objetivo de este trabajo fue determinar el grado de osteo-integración (en la rata) de implantes (alambre de titanio II, 1 mm de diámetro, 4 mm de largo) anodizados en solución de ácido fosfórico 2 M + NaF 0,2 M (implantes-F) comparados con implantes controles, anodizados en solución de ácido fosfórico 2 M. La composición química de la superficie de los implantes fue evaluada mediante el espectro de dispersión de rayos X producidos durante la observación en el microscopio electrónico de barrido. La superficie de los implantes-F contiene 2.57% de flúor. Ratas macho Sprague-Dawley recibieron dos implantes (en el fémur y en tibia, próximos a la rodilla). Los implantes-F y controles se insertaron en las patas izquierda y derecha respectivamente. En los cortes de hueso sin decalcificación previa se midió el contacto hueso-implante (BIC) y volumen óseo en un volumen definido de tejido (BV/TV). BIC fue significativamente mayor con los Implantes-F respecto de los controles (57,2±3,3% vs. 47,9±3,4, p<0,05). BV/TV no exhibió diferencias significativas entre implantes-F y controles (24,5±2,2% vs. 22,9±1,4, p=0,30). Los perfiles de los niveles de grises de los imágenes pseudo3D de las superficies de los implantes pusieron en evidencia la mayor rugosidad de los implantes-F respecto de los controles (p<0,05). Las contribuciones relativas de la rugosidad y del flúor en el proceso de osteo-integración requieren investigación adicional. (AU)


Subject(s)
Animals , Rats , Prostheses and Implants/ultrastructure , Osseointegration/physiology , Bone-Anchored Prosthesis/ultrastructure , Osteoblasts/chemistry , Tibia/cytology , Titanium/chemistry , Bone and Bones/cytology , Bone and Bones/metabolism , Ceftriaxone/administration & dosage , Dental Implants , Diclofenac/administration & dosage , Rats, Sprague-Dawley , Femur/cytology , Fluorides/chemistry , Fluorine/analysis , Isoflurane/administration & dosage , Ketamine/administration & dosage , Acepromazine/administration & dosage
9.
Rev. chil. pediatr ; 88(1): 158-163, 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-844592

ABSTRACT

El síndrome de sensibilidad a fármacos con eosinofilia y síntomas sistémicos es una enfermedad potencialmente mortal, caracterizada por exantema, fiebre, adenopatías, alteraciones hematológicas y compromiso de órganos internos. Objetivo: Presentar una afección poco frecuente en pediatría para facilitar la sospecha diagnóstica y el rápido reconocimiento por parte de los médicos. Caso clínico: Lactante de 9 meses hospitalizada por un cuadro de neumonía viral grave con ventilación mecánica no invasiva, tratada con ceftriaxona entre otros medicamentos. Al quinto día de suspendido el antibiótico presentó un exantema maculopapular violáceo, confluente de predominio en el tronco, la cara y las extremidades superiores, asociado a fiebre, eosinofilia y elevación de transaminasas. Se manejó con prednisona oral más corticoides tópicos por 6 semanas, con buena evolución a los 3 meses de seguimiento. Conclusiones: El diagnóstico de síndrome de sensibilidad a fármacos con eosinofilia y síntomas sistémicos se realiza por clínica y exámenes de laboratorio, además de biopsia cutánea en caso de duda diagnóstica. Si bien su causa más frecuente son los anticonvulsivantes se han descrito casos con un sinnúmero de fármacos. El manejo consiste en la suspensión del fármaco sospechoso asociado a medidas de soporte y tratamiento corticosteroide por tiempos prolongados.


Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, potentially life-threatening, drug-induced hypersensitivity reaction that includes skin eruption, haematological abnormalities, lymphadenopathy, and internal organ involvement. Objective: Presenting a rare condition in children, to facilitate a rapid diagnostic suspicion and recognition by doctors. Case report: An 9 months old infant admitted due to a severe viral pneumonia, managed with non-invasive ventilation and ceftriaxone. Five days after stopping antibiotics, a confluent maculopapular rash appeared, which was predominantly in the trunk, face and upper extremities, combined with a fever, eosinophilia, and elevated serum levels of transaminase. She received treatment with oral prednisone and topical corticosteroids for 6 weeks, with a good outcome after 3 months. Conclusions: The diagnosis of DRESS syndrome is made using clinical criteria, laboratory values, and histopathology, if there is any query. Although it is classically caused by anticonvulsants and sulphonamides, many other drugs have been implicated. The offending drug should be immediately discontinued and the patient given supportive treatment, and systemic corticosteroids for long periods of treatment.


Subject(s)
Humans , Female , Infant , Ceftriaxone/adverse effects , Drug Hypersensitivity Syndrome/diagnosis , Anti-Bacterial Agents/adverse effects , Pneumonia/drug therapy , Ceftriaxone/administration & dosage , Prednisone/therapeutic use , Follow-Up Studies , Drug Hypersensitivity Syndrome/etiology , Drug Hypersensitivity Syndrome/drug therapy , Glucocorticoids/therapeutic use , Anti-Bacterial Agents/administration & dosage
10.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Oliveira Junior, Múcio Tavares de; Kalil Filho, Roberto. Manual da condutas da emergência do InCor: cardiopneumologia / IInCor Emergency Conduct Manual: Cardiopneumology. São Paulo, Manole, 2ª revisada e atualizada; 2017. p.830-837.
Monography in Portuguese | LILACS | ID: biblio-848520
11.
Brasília; CONITEC; 2015.
Non-conventional in Portuguese | LILACS, BRISA | ID: biblio-874950

ABSTRACT

CONTEXTO: A sífilis é uma doença sexualmente transmissível, causada pela bactéria Treponema Pallidum, infecciosa e sistêmica, a partir de sua manifestação. A prevalência da sífilis em parturientes foi de 1,6%, em 2004, e de 1,1%, em 2006. O protocolo clínico e diretrizes terapêuticas (PCDT) de atenção integral às pessoas com Infecções Sexualmente Transmissíveis (IST) está sendo revisado e dentre as recomendações propostas está o uso de ceftriaxona 500mg injetável, como alternativa ao tratamento da gestante com sífilis e com alergia confirmada à penicilina, no caso de total impossibilidade de sua dessensibilização à penicilina. A ceftriaxona, na forma farmacêutica pó para solução injetável e nas concentrações 250mg e 1g, já é disponibilizada pelo SUS. Entretanto, como medida cautelar para mitigar a resistência bacteriana à ceftriaxona, o novo PCDT de Atenção Integral às Pessoas com IST. TRATAMENTO RECOMENDADO: A penicilina G, administrada via parenteral, é a única terapia com eficácia documentada no tratamento de gestantes com sífilis e na prevenção da transmissão vertical da doença para o bebê, apresentando 98% de taxa de sucesso nessa prevenção. O Ministério da Saúde recomenda o uso da penicilina no tratamento da sífilis materna durante a gestação. As gestantes com alergia comprovada à penicilina, após testes de sensibilidade, devem ser dessensibilizadas e posteriormente tratadas com penicilina, em ambiente hospitalar. Na impossibilidade de tratamento com penicilina, as gestantes devem ser tratadas com eritromicina (estearato) 500 mg, por via oral; entretanto, essa gestante não será considerada adequadamente tratada para fins de transmissão fetal, sendo obrigatória a investigação e o tratamento adequado da criança logo após seu nascimento. O uso de tetraciclina, doxiciclina e estolato de eritromicina é contra-indicado na gestação. EVIDÊNCIAS CIENTÍFICAS: em busca realizada na literatura científica, foi encontrada uma série de casos que avaliou a eficácia da ceftriaxona em 11 mulheres grávidas com sífilis primária ou secundária. Após 3 meses de tratamento, os títulos séricos de anticorpos não treponêmicos das gestantes diminuíram 4 vezes e não aumentaram em 24 meses de seguimento, chegando a negativar em 10 casos. Não houve manifestações de sífilis congênita em nenhum dos bebês ao nascimento e os testes para sífílis realizados nos bebês foram negativos logo após o nascimento ou 6 meses depois. CONSIDERAÇÕES FINAIS: A ceftriaxona é uma opção de tratamento de gestantes com sífilis e que não podem ser utilizar o tratamento de primeira escolha com penicilina. A substituição da ceftriaxona de 250mg, pela apresentação de 500mg, para o tratamento de gestantes com sífilis e com alergia confirmada à penicilina, atinge uma economia de 73%. DELIBERAÇÃO FINAL: Os membros da CONITEC presentes na reunião do plenário do dia 02/04/2015 deliberaram, por unanimidade, recomendar a incorporação da ceftriaxona 500mg injetável para tratamento da sífilis em gestantes com alergia confirmada à penicilina. DECISÃO: PORTARIA Nº 57, de 1 de outubro de 2015 - Torna pública a decisão de incorporar a ceftriaxona 500mg injetável para o tratamento de sífilis, conforme normas técnicas definidas pelo Ministério da Saúde, no âmbito do Sistema Único de Saúde - SUS.


Subject(s)
Humans , Female , Pregnancy , Penicillins/adverse effects , Ceftriaxone/administration & dosage , Syphilis/drug therapy , Unified Health System , Brazil , Injections, Intradermal , Cost-Benefit Analysis/economics
12.
Brasília; CONITEC; 2015. graf, tab.
Non-conventional in Portuguese | LILACS, BRISA | ID: biblio-874949

ABSTRACT

CONTEXTO: A gonorreia é uma das infecções bacterianas mais frequentes e é causada pela Neisseria gonorrhoeae. Encontra-se atualmente entre as cinco principais infecções sexualmente transmissíveis mais notificadas na população masculina. Dentre as mudanças propostas pelo PCDT para Infecções Sexualmente Transmissíveis - IST em discussão, recebe destaque a alteração do esquema terapêutico atualmente em uso para o controle da Neisseria gonorrhoeae no Brasil, que prevê a substituição da ciprofloxacina 500mg, dose única via oral, pela ceftriaxona 500mg, dose única via intramuscular. Essa alteração tem como principal objetivo conter o desenvolvimento de maior resistência bacteriana aos antibióticos disponíveis na rede pública para o tratamento desse agravo. TRATAMENTO: Para a escolha do tratamento da infecção gonocócica a OMS estabelece critérios de eficácia, segurança, custo, adesão e disponibilidade, nos seguintes termos: -Eficácia: os medicamentos utilizados devem ter uma taxa de cura de pelo menos 95%. Esquemas terapêuticos com eficácia entre 85% e 95% devem ser utilizados com cautela e abaixo de 85% são considerados inaceitáveis. -Segurança: a presença de efeitos colaterais é a segunda maior preocupação na escolha dos tratamentos e desempenha papel de extrema relevância em mulheres grávidas ou em aleitamento, portanto, o nível de toxicidade deve permanecer dentro de padrões aceitáveis para a saúde do paciente, do feto e do bebê. -Custo: o custo do medicamento deve ser analisado e comparado aos custos de retratamento, eventuais complicações, e risco de transmissão e resistência. -Observância e aceitabilidade: os tratamentos devem ser de preferência em dose única e administrados por via oral. -Disponibilidade: os tratamentos selecionados devem levar em conta a aprovação sanitária no país. Além desses critérios, devem ser consideradas as co-infecções existentes e o risco de redução da eficácia para outras indicações terapêuticas. A TECNOLOGIA: A ceftriaxona é um antibiótico de terceira geração da família da cefalosporina registrado na ANVISA, por meio da Resolução 252 de 5 de março de 2001. O medicamento está disponível no mercado em diferentes apresentações, todas injetáveis, sendo indicado para o tratamento de eventos de sepsemia; meningite; infecções intra-abdominais (peritonites, infecções do trato gastrintestinal e biliar); infecções ósseas, articulares, tecidos moles, pele e feridas; infecções em pacientes imunocomprometidos; infecções renais e do trato urinário; infecções do trato respiratório, particularmente pneumonia e infecções otorrinolaringológicas; infecções genitais, inclusive gonorreia; profilaxia de infecções pré-operatórias; Borreliose de Lyme (Doença de Lyme). RECOMENDAÇÃO DA CONITEC: Na 34ª Reunião da CONITEC, realizada no dia 2 de abril de 2015, os membros do plenário deliberaram por unanimidade recomendar a incorporação da ceftriaxona 500mg injetável para o tratamento de gonorreia resistente à ciprofloxacina, conforme normas técnicas definidas pelo Ministério da Saúde. Foi assinado o Registro de Deliberação nº 110/2015. DECISÃO: PORTARIA Nº 58, de 1 de outubro de 2015 - Torna pública a decisão de incorporar a ceftriaxona 500mg injetável para o tratamento de gonorreia resistente à ciprofloxacina, conforme normas técnicas definidas pelo Ministério da Saúde, no âmbito do Sistema Único de Saúde - SUS.


Subject(s)
Humans , Ceftriaxone/administration & dosage , Ciprofloxacin/adverse effects , Gonorrhea/drug therapy , Neisseria gonorrhoeae/drug effects , Brazil , Cost-Benefit Analysis/economics , Drug Resistance, Microbial , Technology Assessment, Biomedical , Unified Health System
13.
West Indian med. j ; 63(1): 101-104, Jan. 2014. ilus
Article in English | LILACS | ID: biblio-1045798

ABSTRACT

Whipple's disease is a rare multi-organ infectious disease caused by Tropheryma whipplei. It is fatal without treatment. We report on a 40-year old Afro-Jamaican man who presented with a six-month history of weight loss and diarrhoea. Investigations revealed iron deficiency anaemia and hypoalbuminaemia. Upper gastrointestinal endoscopy revealed white patchy lesions in the duodenum. The duodenal biopsy showed broadening and thickening of the villi by a dense infiltrate of foamy histiocytes within the lamina propria and focally extending into the attached submucosa. Periodic Acid-Schiff stains were positive. Electron microscopy was confirmatory and polymerase chain reaction testing conclusively identified the organisms as T whipplei. Antibiotic treatment resulted in resolution of symptoms. Although the diagnosis of Whipple's disease is difficult, increased awareness should lead to an increase in reported cases with the improvements in diagnostic capabilities.


La enfermedad deWhipple es una rara enfermedad infecciosa multiorgánica causada por el Tropheryma whipplei. Es fatal sin tratamiento. Reportamos un hombre afro-jamaicano de 40 años que se presentó con una historia de seis meses de pérdida de peso y diarrea. Las investigaciones revelaron hipoalbuminemia y anemia ferropénica. La endoscopia gastrointestinal superior reveló lesiones blancas irregulares en el duodeno. La biopsia duodenal mostró la ampliación y engrosamiento de las vellosidades por un denso infiltrado de histiocitos espumosos dentro de la lámina propia, que se extienden hasta la submucosa adjunta. Las tinciones con ácido peryódico de Schiff fueron positivas. La microscopia electrónica fue confirmatoria y la prueba de la reacción en cadena de la polimerasa, identificó los organismos como T whipplei de forma concluyente El tratamiento antibiótico trajo como resultado la resolución de los síntomas. Si bien el diagnóstico de la enfermedad de Whipple es difícil, un aumento de la conciencia debe conducir a un aumento en los reportes de casos divulgados que reflejan un mejoramiento en la capacidad para hacer el diagnóstico.


Subject(s)
Humans , Male , Adult , Whipple Disease/diagnosis , Biopsy , Ceftriaxone/administration & dosage , Colonoscopy , Whipple Disease/drug therapy , Anti-Bacterial Agents/administration & dosage
14.
Säo Paulo med. j ; 132(2): 121-124, 2014. tab, graf
Article in English | LILACS | ID: lil-705383

ABSTRACT

CONTEXT: Solitary brainstem abscesses are rare and they are usually associated with other infections. They are severe conditions with high morbidity and mortality. The surgical options are stereotactic aspiration and microsurgical drainage. Systemic antibiotic therapy is used for more than six weeks. CASE REPORT: We present the case of a young man with a solitary abscess at the pons, without other systemic infections. The patient was treated by means of microsurgical drainage and antibiotic therapy for three weeks. His postoperative recovery was good. CONCLUSIONS: A microsurgical approach may be considered to be an important option for large abscesses that are multiloculated, close to the surface or contain thick fluid. Complete emptying of the purulent accumulation may diminish the required duration of antibiotic therapy. .


CONTEXTO: Abscessos isolados do tronco encefálico são raros e geralmente associados a outras infecções. Trata-se de condição grave, com grande morbidade e mortalidade. Opções cirúrgicas são aspiração com estereotaxia e drenagem microcirúrgica. Antibioticoterapia sistêmica tem sido usada por mais de seis semanas. RELATO DE CASO: Apresentamos o caso de um jovem com abscesso pontino sem outras infecções sistêmicas. O paciente foi tratado com drenagem microcirúrgica e antibioticoterapia por três semanas. Houve boa evolução pós-operatória. CONCLUSÕES: Acesso microcirúrgico pode ser considerado uma opção importante no tratamento de grandes abscessos do tronco encefálico, que são multiloculados, próximos da superfície ou que contenham líquido espesso. Drenagem completa do material purulento pode diminuir o período de antibioticoterapia. .


Subject(s)
Adult , Humans , Male , Anti-Bacterial Agents/administration & dosage , Brain Abscess/drug therapy , Brain Abscess/surgery , Brain Stem/surgery , Microsurgery/methods , Ceftriaxone/administration & dosage , Magnetic Resonance Imaging , Metronidazole/administration & dosage , Oxacillin/administration & dosage , Suction/methods , Time Factors
16.
Braz. j. infect. dis ; 15(3): 262-267, May-June 2011. tab
Article in English | SES-SP, LILACS, SES-SP | ID: lil-589959

ABSTRACT

BACKGROUND: Bacterial pneumonia is one of the main causes of morbidity and mortality in patients infected by the human immunodeficiency virus (HIV). The main objective of this study was to evaluate the effect of macrolide therapy in combination with a beta-lactam based empiric regimen for inpatients with community-acquired pneumonia and HIV. METHODS: This is a retrospective cohort study of hospitalized patients. Adult patients who had received treatment with ceftriaxone or ceftriaxone plus clarithromycin were included. RESULTS: 76 patients met the inclusion criteria. Among baseline characteristics analyzed, only respiratory rate showed significant difference: patients who had received clarithromycin were more likely to have a respiratory rate > 30/min than patients who received only ceftriaxone (64 percent versus 36 percent, p = 0.03). ICU admission was the only outcome that showed a significant difference, more frequent in the ceftriaxone plus clarithromycin group (45 percent versus 20 percent, p = 0.03). CONCLUSIONS: This study does not support the addition of a macrolide to a beta-lactam based regimen in HIV-infected patients. This is probably related to the patients' immunodeficiency status, which impairs the immunomodulatory properties of the macrolides.


Subject(s)
Adult , Female , Humans , Male , AIDS-Related Opportunistic Infections/drug therapy , Anti-Bacterial Agents/administration & dosage , Ceftriaxone/administration & dosage , Clarithromycin/administration & dosage , Pneumonia, Bacterial/drug therapy , AIDS-Related Opportunistic Infections/mortality , Cohort Studies , Community-Acquired Infections/drug therapy , Community-Acquired Infections/mortality , Drug Therapy, Combination/methods , Pneumonia, Bacterial/mortality , Retrospective Studies
17.
Rev. panam. salud pública ; 29(6): 444-450, June 2011. ilus, tab
Article in English | LILACS | ID: lil-608276

ABSTRACT

OBJECTIVE: To compare clinical response to initial empiric treatment with oxacillin plus ceftriaxone and amoxicillin plus clavulanic acid in hospitalized children diagnosed with very severe community-acquired pneumonia (CAP). METHODS: A prospective randomized clinical study was conducted among children 2 months to 5 years old with a diagnosis of very severe CAP in the pediatric ward of São Paulo State University Hospital in Botucatu, São Paulo, Brazil, from April 2007 to May 2008. Patients were randomly divided into two groups by type of treatment: an oxacillin/ceftriaxone group (OCG, n = 48) and an amoxicillin/clavulanic acid group (ACG, n = 56). Analyzed outcomes were: time to clinical improvement (fever and tachypnea), time on oxygen therapy, length of stay in hospital, need to widen antimicrobial spectrum, and complications (including pleural effusion). RESULTS: The two groups did not differ statistically for age, sex, symptom duration before admission, or previous antibiotic treatment. Time to improve tachypnea was less among ACG patients than OCG patients (4.8 ± 2.2 versus 5.8 ± 2.4 days respectively; P = 0.028), as was length of hospital stay (11.0 ± 6.2 versus 14.4 ± 4.5 days respectively; P = 0.002). There were no statistically significant differences between the two groups for fever improvement time, time on oxygen therapy, need to widen antimicrobial spectrum, or frequency of pleural effusion. CONCLUSIONS: Both treatment plans are effective in treating very severe CAP in 2-month-to 5-year-old hospitalized children. The only analyzed outcome that favored amoxicillin/clavulanic acid treatment was time required to improve tachypnea.


OBJETIVO: Comparar la respuesta clínica al tratamiento empírico inicial con oxacilina más ceftriaxona frente a amoxicilina más ácido clavulánico en niños hospitalizados con diagnóstico de neumonía extrahospitalaria muy grave. MÉTODOS: Se llevó a cabo un estudio clínico prospectivo aleatorizado en niños de 2 meses a 5 años de edad con diagnóstico de neumonía extrahospitalaria muy grave en la sala de pediatría del Hospital Universitario del Estado de São Paulo en Botucatu, São Paulo, Brasil, entre abril del 2007 y mayo del 2008. Los pacientes se dividieron aleatoriamente en dos grupos según el tratamiento administrado: un grupo recibió oxacilina/ceftriaxona (n = 48) y otro amoxicilina/ácido clavulánico (n = 56). Los criterios de valoración analizados fueron el tiempo hasta la mejoría clínica (de la fiebre y la taquipnea), el tiempo de administración de oxigenoterapia, la duración de la internación, la necesidad de ampliar el espectro antibiótico y las complicaciones (como el derrame pleural). RESULTADOS: Los dos grupos no presentaban diferencias estadísticas con respecto a la edad, el sexo, la duración de los síntomas antes de la internación o el tratamiento previo con antibióticos. El tiempo hasta la mejoría de la taquipnea fue menor en los pacientes tratados con amoxicilina/ácido clavulánico que en los que recibieron oxacilina/ceftriaxona (4,8 ± 2,2 días frente a 5,8 ±2,4 días, respectivamente; P = 0,028), y también fue menor la duración de la internación (11,0 ± 6,2 días frente a 14,4 ± 4,5 días, respectivamente; P = 0,002). No hubo diferencias estadísticamente significativas entre los dos grupos en relación con el tiempo hasta la mejoría de la fiebre, el tiempo de administración de oxigenoterapia, la necesidad de ampliar el espectro antibiótico ni la frecuencia de derrame pleural. CONCLUSIONES: Ambos esquemas de tratamiento son eficaces para tratar la neumonía extrahospitalaria muy grave en niños de 2 meses a 5 años de edad hospitalizados. El único criterio de valoración analizado que favoreció el tratamiento con amoxicilina/ ácido clavulánico fue el tiempo hasta la mejoría de la taquipnea.


Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Anti-Bacterial Agents/therapeutic use , Community-Acquired Infections/drug therapy , Pneumonia, Bacterial/drug therapy , Amoxicillin-Potassium Clavulanate Combination/administration & dosage , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Combined Modality Therapy , Ceftriaxone/administration & dosage , Ceftriaxone/therapeutic use , Community-Acquired Infections/complications , Community-Acquired Infections/therapy , Hospitals, Pediatric , Inpatients , Oxygen Inhalation Therapy , Oxacillin/administration & dosage , Oxacillin/therapeutic use , Prospective Studies , Pneumonia, Bacterial/complications , Pneumonia, Bacterial/therapy , Time Factors , Treatment Outcome , Tachypnea/drug therapy , Tachypnea/etiology
18.
Braz. j. infect. dis ; 13(5): 391-393, Oct. 2009. ilus
Article in English | LILACS | ID: lil-544996

ABSTRACT

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by actinomyces israeli. Intravenous penicillin is the preferred antimicrobial but it requires hospitalization up to one month. An outpatient treatment strategy would be cost effective and a good choice for patients. Here we present three cases in which intramuscular ceftriaxone was successfully used in the outpatient settings following surgery and IV penicillin treatment in the hospital.


Subject(s)
Adult , Female , Humans , Middle Aged , Actinomycosis/drug therapy , Anti-Bacterial Agents/administration & dosage , Ceftriaxone/administration & dosage , Pelvic Infection/drug therapy , Penicillins/administration & dosage , Ambulatory Care , Injections, Intramuscular , Pelvic Infection/microbiology , Treatment Outcome
19.
Rev. chil. infectol ; 26(4): 350-354, ago. 2009. ilus, graf
Article in Spanish | LILACS | ID: lil-527878

ABSTRACT

Objective: To describe the feasibility, effectiveness and safety of intravenous (iv) outpatient treatment in 2 to 24 month-old children with febrile urinary tract infection (UTI). Method: Children presenting to the ER, between April 2003-2005, with fever and no identifiable focus who had a diagnosis of UTI were randomized to receive iv antibiotic in the hospital or in an outpatient facility. Children were started on amikacin or ceftriaxona according to physician criteria followed by antimicrobial adjustment based on uriñe culture result and a later switch to an oral antimicrobial. Uriñe cultures were performed during and after completing the antimicrobial course. Adherence and effectiveness of antimicrobial treatment and treatment-associated complications were analyzed. Results: The study included 112 patients, 58 inpatient children and 54 outpatient children, with an average age of 7.7 months. Duration of iv treatment didnot differ among groups (2.8 days (SD 1.2) 2.7 +0.91 days ininpatients vs 2.9 + 1.9 days in outpatients (p = 0.22). In 100 percent of outpatient children and 100 percent of inpatient children (overall 101/101) uriñe cultures were negative on day 5. None of the children had a treatment-associated complication. Cost analysis yielded 73 percent of saving money (overall cost for inpatient treatment US 9,815 vs outpatient treatment US 2,650). Conclusions: Outpatient iv treatment in patients between 2 and 24 months with UTI and fever was effective, safe and of lower cost.


Objetivo: Describir la factibilidad, efectividad y seguridad del tratamiento intravenoso (iv) ambulatorio en niños de 2 meses a 2 años con infección del tracto urinario (ITU) y fiebre. Método: Entre abril 2003 y abril 2005 se realizó un estudio prospectivo en pacientes con fiebre sin foco derivados de Emergencia Infantil, finalmente diagnosticados como ITU, estableciéndose dos grupos con tratamiento iv: uno hospitalizado y otro ambulatorio. Se administró amikacina o ceftriaxona según criterio del médico de turno, hasta obtener resultado del urocultivo, y posteriormente se cambió a tratamiento oral. Se controló urocultivo intra y post tratamiento registrándose adherencia, efectividad y complicaciones. Resultados: Se incluyeron 112 pacientes (58 hospitalizados y 54 ambulatorios), con edad promedio de 7,8 meses. El promedio de días de tratamiento iv fue 2,8 días (SD 1,2) sin diferencias significativas entre ambos grupos 2,7 +0,91 días en los internados vs 2,9 + 1,9 días en los ambulatorios (p = 0,22). En 100 por ciento de ambos grupos de pacientes (en globo 101/101) el urocultivo obtenido al día 5 fue estéril. No hubo complicaciones del tratamiento o sobre la vía venosa. El análisis de costos concluyó que en globo, el manejo ambulatorio representó un 73 por ciento de ahorro económico (1.430.000 pesos chilenos vs 5.300.000 pesos en el sólo rubro de día-cama Conclusiones: El tratamiento iv ambulatorio en pacientes con ITU febril entre 2 y 24 meses fue efectivo, seguro y a un menor costo.


Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Amikacin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Ceftriaxone/administration & dosage , Fever/drug therapy , Urinary Tract Infections/drug therapy , Ambulatory Care , Fever/microbiology , Hospitalization , Infusions, Intravenous/economics , Medication Adherence , Prospective Studies , Time Factors , Treatment Outcome , Urinary Tract Infections/diagnosis , Urinary Tract Infections/microbiology
20.
Article in English | WPRIM | ID: wpr-180443

ABSTRACT

A 48-year-old man presented with visual dimness in the right eye that had developed 2 weeks previously. Dilated fundus examination showed few vitreous cells and numerous yellow, placoid lesions in both eyes. His right eye had more severe serous retinal detachment involving the macula. Fluorescein angiography demonstrated early irregular hypofluorescence with late staining in the areas of the yellow placoid lesions. He started a regimen of 60 mg of oral prednisone daily. Two weeks later, a serologic fluorescent treponemal antigen absorption test was positive for Ig G and Ig M. He was referred to an infectious disease specialist for antibiotic therapy. A week later, he returned, having stayed on prednisone only and not having taken the internist's antibiotic prescription. Meanwhile, the chorioretinitis in his right eye, which had initially been at a more advanced stage, was resolved with the use of steroids. The chorioretinitis in his left eye, which was aggravated at an earlier stage, ultimately recovered. Our case had atypical courses such that one eye improved and the other worsened during the same steroid treatment period. This result was inconsistent with that of previous reports showing that oral steroid influences the clinical course of acute syphilitic posterior placoid chorioretinitis.


Subject(s)
Acute Disease , Anti-Bacterial Agents/administration & dosage , Ceftriaxone/administration & dosage , Chorioretinitis/diagnosis , Diagnosis, Differential , Eye Infections, Bacterial/diagnosis , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Humans , Injections, Intravenous , Male , Middle Aged , Syphilis/diagnosis
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