Reposicionando la cloxacilina como antibioticoterapia empírica inicial de la sepsis tardía neonatal / Reinstating cloxacilin for empiric antibiotic in late-onset sepsis

Vancomycin has been used for more than 50 years in neonatal intensive care units (NICUs) as the therapy of choice for late-onset sepsis, mainly because Coagulase negative Staphylococci (CoNS) are common and mostly resistant to oxacyllin despitelow virulence and unusual association with fulminant sepsis. CUs due to several factors including its high pharmacokinetic variability, difficulty in reaching therapeutic plasmatic drug concentrations and progressively increasing minimum inhibitory concentrations (MIC). The increase of CoNS with higher MICs as well as the rise of infections caused by resistant gram-negative bacilli and candida should move to reconsider Vancomycin as first line treatment. Infections in neonates have a different behavior than in other populations and we consoder of utmost importance to consider the use of oxacyllin as first line antimicrobial therapy for late-onset sepsis.

Vancomicina se utiliza hace más de 50 años en unidades de cuidados intensivos neonatales (UCIN) como terapia de elección en sospecha de sepsis neonatal tardía; su principal indicación se fundamenta en que Staphylococcus coagulasa negativa (SCN) es el principal microorganismo que ocasiona sepsis tardía y éste es habitualmente resistente a cloxacilina; sin embargo, su virulencia es baja y la sepsis fulminante es inusual. Lamentablemente la prescripción de vancomicina se ha convertido en un grave problema en las UCIN, debido a diversas razones incluyendo: alta variabilidad farmacocinética del fármaco, dificultad en alcanzar concentraciones plasmáticas apropiadas y aumento de la concentración inhibitoria mínima (CIM), implicando además una mayor probabilidad de seleccionar cepas resistentes y aumento de otro tipo de infecciones ocasionadas por bacilos gramnegativos resistentes y candidiasis invasora. Considerando lo anteriormente señalado y a lo publicado en la literatura médica con respecto a las infecciones en neonatología, debido a su comportamiento clínico diferente a hospederos en otras etapas de la vida, resulta de suma importancia replantear el uso de vancomicina basado en fundamentos teóricos que avalen la seguridad de no utilizar este antimicrobiano como primera línea en sepsis neonatal tardía.

Reacciones adversas medicamentosas mucocutáneas en pacientes hospitalizados en servicio de medicina interna / Mucocutaneous adverse reactions to drugs in hospitalized patients of internal medicine service

Las reacciones adversas medicamentosas mucocutáneas (RAMM) son una de las manifestaciones más frecuentes de reacción adversa a medicamentos. Su incidencia según datos internacionales alcanza un 2 por ciento a 3 por ciento en pacientes hospitalizados. Nosotros investigamos la incidencia de RAMM en el Servicio de Medicina Interna del Hospital Base de la ciudad de Los Ángeles. En el período junio-septiembre de 2006 se hospitalizaron 1.052 pacientes, diagnosticándose 3 casos de RAMM que representan un 0,3 por ciento. Se identificaron los fármacos atribuibles a las RAMM, correspondiendo a cloxacilina, toxoide tetánico y drogas antituberculosas; éstas se compararon posteriormente con un grupo control. Los casos identificados fueron un rash morbiliforme, una reacción inflamatoria local tipo celulitis y un rash urticariforme. La incidencia obtenida fue más baja de lo esperado, atribuyéndose a las características de atención del centro estudiado.

Mucocutaneous adverse reactions to drugs (MCRD) are one of the most frequent manifestations of adverse drug reaction. Its incidence, according to international data, reaches 2 to 3 percent in hospitalized patients. We studied the incidence of MCRD in the Internal Medicine Service of the Base Hospital, located in the city of Los Angeles, Chile. 1,052 patients were hospitalized during the June-September 2006 period, and three cases of MCRD were diagnosed, representing 0.3 percent. The drugs causing to MCRD were cloxacilin, tetanic toxoid and antituberculosis drugs; these were later compared to a control group. The identified cases were morbiliform rash, a cellulitis-type local inflammatory reaction, and urticariform rash. The obtained incidence was lower than expected, attributed to the characteristics of the studied center.

Eosinophilic pleural effusion due to cloxacillin and piperacillin/tazobactum

A young male was treated for right-sided pneumonia with cloxacillin and piperacillin/tazobactam. As he was recovering from the pneumonia he developed left-sided pleuritic pain and pleural effusion. At thoracocentesis an exudative pleural effusion contained 16 percent eosinophils with a simultaneous 28 percent peripheral eosinophilia. An allergic reaction to penicllins was thought to be the cause. After withdrawal of those medications and institution of prednisolone a rapid resolution was seen of symptoms, signs, peripheral eosinophilia and radiological abnormalities

Antibiotic associated diarrhoea: a controlled study comparing plain antibiotic with those containing protected lactobacilli.

Antibiotic associated diarrhoea is known to occur with broad spectrum antibiotics. Lactobacillus has been used for prophylaxis and therapy of this condition. In a double blind controlled study, the antibiotic containing ampicillin (250 mg) and cloxacillin (250 mg) with or without protected lactobacilli was evaluated in 740 patients undergoing cataract surgery. The incidence of diarrhoea in patients receiving plain antibiotic was 13.3% compared to 0.0% in patients receiving antibiotic with protected lactobacilli (p<0.001). The study demonstrates that antibiotic formulations containing protected lactobacilli maintain prophylactic effect of lactobacilli.

Isquemia aguda de la mano secundaria a la admmnistración intraarterial de cloxacilina / Hand acute ischemia secondary to the intraarterial administration of cloxaciline

La isquemia aguda de la mano, luego de la inyección intraarterial de medicamentoses un problema frecuente, de difícil manejo, y que requiere tratamiento médico urgente. Este reporte describe un caso de inyección inadvertido de cloxacilina en arteria humeral, con isquemia grave de mano, que llegó a la amputación digital. Se discute patogénesis y opciones de tratamiento

Estudio clínico comparativo de mupirocine tópico y cloxacilina oral en el tratamiento de infecciones cutáneas / Comparative clinique study of topical mupirocine and oral cloxacillin in the treatment of skin infections

Comparamos en un estudio randomizado la efectividad en el tratamiento de enfermedades cutáneas superficiales con mupirocine tópico y cloxacilina oral. Los resultados demostraron un a mejor respuesta con mupirocine, con 85,7 por ciento de eliminación bacteriana a la semana post-tratamiento versus un 54,5 por ciento con cloxacilina. No se reportaron efectos sistémicos colaterales con mupirocine excepto prurito y sensación de ardor

Neutropenia associated with cloxacillin and other semisynthetic penicillins in children

Five children treated with high dose of semisynthetic penicillin for three to four weeks developed neutropenia [< 1.5 x 10[9]/L]. All patients were on cloxaxillin. In addition, three patients received ampicillin, and one received piperacillin therapy for the same duration. All patients developed neutropenia 15 to 23 days following therapy and resolved 8 to 95 days after discontinuation of the penicillin. One patient developed serious perianal necrotizing fascitis as a complication of neutropenia. The red blood cell count and platelets were normal in all patients. Bone marrow aspiration performed on two patients revealed a maturation arrest of the granulocyte precursor. A complete cell count and differential should be monitored during high dose penicillin therapy