RESUMO
Abstract Background Febrile neutropenia (FN) is a common complication in children who receive chemotherapy for cancer. Objective The objective of this study was to evaluate the clinical efficacy of the continuous versus intermittent infusion of piperacillin/tazobactam (TZP) in febrile neutropenic pediatric patients. Methods This is a non-blinded randomized controlled clinical trial. Eligible group consisted of hemato-oncological patients with FN who were candidates to receive TZP. Patients were randomized to one of two groups: Group 1 received antibiotic treatment through intravenous intermittent infusion of TZP 300 mg/kg/day based on piperacillin, divided into four doses, not exceeding 16 g/day; Group 2 received an initial TZP loading dose of 75 mg/kg infusion over 30 min, and then a continuous infusion of TZP 300 mg/kg/day through central line with pump over 24 h. Results There were 176 episodes that could be assessed, 100 in Group 1 and 76 in Group 2. There was no statistically significant difference in treatment failure in the experimental group (continuous infusion) compared with the intermittent group, 21% versus 13% (p = 0.15). The increase in the absolute risk reduction was 0.08% (95% confidence interval 0.12-0.30), and the number needed to treat was 12.4. One patient in each group died. Conclusions There were no differences in fever resolution, clinical cure rate, or mortality when comparing the continuous with the intermittent TZP infusion.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Neutropenia Febril/tratamento farmacológico , Combinação Piperacilina e Tazobactam/administração & dosagem , Antibacterianos/administração & dosagem , Neoplasias/tratamento farmacológico , Antineoplásicos/efeitos adversos , Infusões Intravenosas , Esquema de Medicação , Antineoplásicos/administração & dosagemRESUMO
La fascitis necrosante es una infección grave de los tejidos blandos, aunque es poco frecuente, presenta una alta tasa de mortalidad, y de no ser diagnosticada rápidamente suele ser fulminante. Su diagnóstico se realiza principalmente por sospecha clínica y confirmación por cirugía; sin embargo, el apoyo imaginológico de la tomografía computarizada (TC) y la resonancia magnética (RM) han sido de gran ayuda. Se trata del caso clínico de un menor de edad, con dolor de alta intensidad y eritema en glúteo y miembro inferior secundario a inyección intramuscular, en quien el diagnóstico se sospecha inicialmente por ecografía y TC. Se destacan los hallazgos imaginológicos y la importancia de estas técnicas para su diagnóstico.
Necrotizing Fasciitis is a severe soft tissue infection, which although infrequent, has a high mortality rate and can be fatal if not diagnosed promptly. Diagnosis is primarily made by clinical suspicion and confirmation by surgery; however imaging support of computed tomography and magnetic resonance imaging are helpful. We present a case of a child with high intensity pain and erythema in buttock and lower limb secondary to intramuscular injection, in which the diagnosis was initially suspected by ultrasonography and computed tomography.
Assuntos
Humanos , Fasciite Necrosante , Tomografia , Infecção FocalRESUMO
La osteolielitis por Nocardia es una enfermedad oportunista, y bastante rara según estudios. Se relata un caso de un paciente, su diagnóstico y tratamiento de la misma.