Uso de antibióticos en México: revisión de problemas y políticas: [revisión] / Antibiotic use in Mexico: review of problems and policies: [review]

El uso inadecuado de antibióticos representa un riesgo para la salud y un desperdicio de recursos económicos en los servicios de salud. Además, contribuye al aumento de la resistencia bacteriana que, a su vez, incrementa los gastos y la mortalidad por enfermedades infecciosas, por lo que se le considera un grave problema de salud pública. Al respecto, la Organización Mundial de la Salud ha recomendado una serie de estrategias fundadas en las políticas farmacéuticas nacionales. En México, diversos aspectos sobre el uso inapropiado de antibióticos han sido documentados. En respuesta se han desarrollado principalmente intervenciones educativas y gerenciales dirigidas a médicos en servicios públicos de salud, así como programas de vigilancia epidemiológica. La investigación y las intervenciones enfocadas en consumidores, farmacias y el sector privado son escasas. Fundamentalmente, no existe una estrategia nacional sobre antibióticos que se refleje en las políticas farmacéuticas y de salud del país.

The inappropriate use of antibiotics signifies a risk for individual health and a waste of health resources. It triggers the development of antibiotic resistance, which increases expenditures and mortality related to infectious disease, and is hence considered a serious public health problem. The World Health Organization has thus recommended a series of strategies to be included within national pharmaceutical policies. In Mexico, diverse factors related to the inappropriate use of antibiotics have been documented. While the response has been mainly in the form of educational and managerial interventions directed toward physicians in public health services, as well as epidemiological surveillance, there is a paucity of research and interventions focused on consumers, pharmacies, and the private sector. Fundamentally, a comprehensive national strategy for antibiotics is not incorporated into health and pharmaceutical policies.

Impacto de Streptococcus pneumoniae en las neumonias del niño latinoamericano / Impact of Streptococcus pneumoniae in Latin American children

La neumonia adquirida en la comunidad es una de las principales causas de morbilidad y mortalidad en la infancia. Estudios realizados en paises en desarrollo indican que los cuadros de neumonia mas graves se asocian a causas bacterianas, con predominio de Streptococcus pneumoniae, seguido por Haemophilus influenzae tipo b. El manejo de esas infecciones en los menores de 2 años se ve dificultado por la carencia de vacunas apropiadas y por la disminucion de la susceptibilidad de S. pneumoniae a la penicilina y a otros antibioticos. En 1993, por iniciativa del Sistema Regional de Vacunas (SIREVA) de la Organizacion Panamericana de la Salud y con la financiacion de la Agencia Canadiense para el Desarrollo Internacional (Canadian International Development Agency: (CIDA), se diseño un estudio para identificar los tipos capsulares de S. pneumoniae que causan enfermedad invasora en los niños latinoamericanos menores de 5 años, con el proposito de determinar tanto la composicion ideal de una vacuna conjugada que pudiera emplearse en la Region como la susceptibilidad a la penicilina de los aislados de S. pneumoniae. La iniciativa fue aceptada por Argentina, Brasil, Colombia, Chile, Mexico y Uruguay. En este informe se analiza la informacion sobre la neumonia por S. pneumoniae generada en los paises participantes. Se captaron 3.393 niños con infecciones sistemicas por S. pneumoniae, de las cuales 1.578 correspondian a neumonias. El analisis se concentro en los 1.409 casos de neumonia de Argentina, Brasil, Colombia, Mexico y Uruguay. La distribucion por edades evidencio un franco predominio de los menores de 2 años (63.8 por ciento). Se identificaron 12 tipos capsulares prevalentes, de los cuales los serotipos 14, 5 y 1 ocuparon los tres primeros lugares en la mayoria de los paises

Community-acquired pneumonia is one of the leading causes of infant morbidity and mortality. Studies conducted in developing countries indicate that the most serious symptoms of pneumonia are associated with bacterial causes, mainly Streptococcus pneumoniae, followed by Haemophilus influenzae type b. Managing those infections in children under two years of age is hindered by the lack of appropriate vaccines and by the decreased susceptibility of S. pneumoniae to penicillin and other antibiotics. In 1993, at the initiative of the Regional System for Vaccines of the Pan American Health Organization, and with funding from the Canadian International Development Agency, a study was designed to identify the S. pneumoniae capsular types that cause invasive disease in Latin American children under 5 years of age. The objective of the study was to determine the ideal composition of a conjugate vaccine that could be used in Latin America, and the penicillin susceptibility of the S. pneumoniae isolates. The initiative was undertaken in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay. This report analyzes the information that the participating countries generated on pneumococcal pneumonia. A total of 3 393 children were found with systemic S. pneumoniae infections, of which 1 578 corresponded to pneumonias. The analysis focused on 1 409 cases of pneumonia in Argentina, Brazil, Colombia, Mexico, and Uruguay. Of the children, 63.8% of them were under two years of age. Twelve prevalent capsular types were identified, of which serotypes 14, 5, and 1 were the three most common in the majority of the countries. At the beginning of the study the highest level of penicillin resistance was found in Mexico (47.0%), and the lowest in Colombia (12.1%). Over the 1993­1998 period, resistance to penicillin increased in the five countries. Penicillin resistance was associated with a small number of capsular serotypes, mainly 14 and 23F. The first of those serotypes was resistant to penicillin and to trimethoprim-sulfamethoxazole, and the second was multiresistant. The frequency of resistance to trimethoprim-sulfamethoxazole was high in all of the countries; Argentina had the highest level, 58.0%. A decrease in susceptibility to chloramphenicol was uncommon, except in Colombia, where there was a resistance level of 23.4%. Resistance to erythromycin was low in all the countries, and all the isolates were susceptible to vancomycin.