Adenitis cervical con anaerobios sin causa aparente en lactante / Cervical adenitis with anaerobes without apparent cause in infant

Las adenopatías cervicales benignas en lactantes son relativamente frecuentes, se definen como el aumento de volumen ganglionar de más de 1 cm, sin síntomas sistémicos y cuando están presentes, el término correcto es adenitis. Para su estudio, las adenitis se dividen en: locales, sistémicas, unilaterales, bilaterales, agudas, crónicas, y por edad, con diferentes etiologías. Se presenta el caso clínico de un lactante de 11 meses de edad con diagnóstico de adenitis cervical abscedada unilateral aguda, con cuadro de 72 h de evolución, con crecimiento constante a nivel cervical derecho, compromiso del estado general, fiebre y anorexia, por lo que se inician antibióticos de primera línea para los agentes bacterianos más frecuentes (Staphylococcus aureus y Streptococcus pyogenes), con evolución tórpida a las 48 h, por lo que se solicita ultrasonido cervical, ya que la familia no contaba con recursos para solicitar cultivo o tomografía, reportando el ultrasonido ganglio cervical de 3,5 cm de diámetro abscedado, por lo que se agrega cobertura para anaerobios, con respuesta muy favorable a las 24 h. Queda la duda del origen de los anaerobios en la paciente, sin antecedentes de importancia y en grupo etario diferente al afectado por esos gérmenes. Consideramos este caso interesante por su comportamiento atípico, para el enriquecimiento del ejercicio de la otorrinolaringología, recalcando el invaluable apoyo de la clínica y solo con un ultrasonido, ya que no siempre se tendrán todos los recursos disponibles, pero siguiendo las pautas de lo reportado en la literatura, se tuvo una resolución exitosa.

Benign cervical lymphadenopathies in infants are relatively frequent, they are defined as an increase in lymph node volume of more than 1 cm, without systemic symptoms, and when they are present, the correct term is adenitis. For its study, adenitis is divided into: local, systemic, unilateral, bilateral, acute, chronic, and by age, with different etiologies. An 11-month-old infant with a diagnosis of acute unilateral abscessed cervical adenitis, with a 72 h evolution, with constant growth at the right cervical level, fever and anorexia, for which first-line antibiotics were started to the most frequent bacterial agents (Staphylococcus aureus and Streptococcus pyogenes), with torpid evolution at 48 h, for which only cervical ultrasound is requested, since the family did not have the resources to request culture or tomography, reporting the cervical ganglion ultrasound of 3.5 cm of abscessed diameter, so coverage for anaerobes is added, with a very favorable response at 24 hrs. There remains the doubt of the origin of the anaerobes in the patient, without important antecedents and in an age group different from that affected by these germs. We consider this case interesting due to its atypical behavior, for the enrichment of the otolaryngology exercise, emphasizing the invaluable support of the clinic, and only with an ultrasound, since other clinical tools were not available, but following the guidelines of what is reported in literature, there was a successful resolution.

Efficacy and Safety of Fixed Dose Combination of Cefpodoxime Proxetil and Potassium Clavulanate (Cefchamp) in Comparison with Cefuroxime Axetil in Patients with Lower Respiratory Tract Infections.

Objectives: To evaluate the efficacy and safety of Fixed Dose Combination of Cefpodoxime Proxetil and Potassium Clavulanate (Cefchamp) in comparison with Cefuroxime Axetil in patients with Lower Respiratory Tract Infections.Methods:In this open, randomized, and controlled, parallel-group study of 7 days, 57 patients of both gender above 18 years of age with diagnosis of lower respiratory tract infection were randomized to receive Fixed Dose Combination (FDC) of Cefpodoxime Proxetil plus Potassium Clavulanate (Cefchamp), or Cefuroxime Axetil (CA) for a period of 7 days. Efficacy was assessed by symptoms of cough, dyspnoea, wheezing, Rhonchi, and chest pain based on 4-point scale as 0=none,1=mild, 2=moderate, 3=severe. Fever was recorded as the patient’s actual temperature. Safety assessment included adverse events and adverse drug reactions during the study period.Results: Three patients lost to follow up with CA.The improvement in all symptoms except cough was greater with CC as compared to CA group(p, >0.05). Fever improved from 37.18°C at baseline to 37.01 on day 3 with CC, whereas with CA the fever improved from 37.l5 at baseline to 37.05 on day 3 with CA. Fever subsided in all the patients in both treatments by day 5 of study therapy. Clinical cure was seen in 57.14% (16/28) patients on CC, whereas 42.3% patients (11/26) on CA had clinical cure.Conclusions:The fixed dose combination of Cefpodoxime Proxetil 200 mg and Potassium Clavulanate 125mg (Cefchamp) in comparison with Cefuroxime Axetil 500 mg showed improvement in the cure of respiratory tract infections in terms of decreasing the patient’s LRTI symptoms, improving the patient’s general health and with few adverse events and adverse drug reactions. However, further studies of greater sample size and blinded nature are needed to further substantiate this effect.

Comparative study of three antimicrobial drugs protocol (Ceftriaxone, Gentamicin/Amikacin and Metronidazole) versus two antimicrobial drugs protocol (Ceftriaxone and Metronidazole) in cases of intra-abdominal sepsis.

BACKGROUND: Treatment of intra-abdominal sepsis with antibacterial drugs should be initiated as soon as possible diagnosis is made before surgery and continued in the post operative period, unless required to be changed (when there is no satisfactory clinical response). The ideal agent (s) and duration of therapy remains somewhat controversial. However, early experimental and subsequent clinical studies have indicated that the spectrum of chosen antibacterial activity must encompass both colonic aerobes and anaerobes including B. fragilis. There are a number of multi drug protocols that are used to treat intra-abdominal septic conditions. Empiric use of these protocols not only adds toxicity to already ill patient but therapy becomes costly and utilizes human resource, unnecessarily. AIM OF STUDY: To study the clinical efficacy of the treatment of intra-abdominal sepsis with protocol -A (Ceftriaxone, Metronidazole and aminoglycoside) versus protocol -B. (Ceftriaxone and Metronidazole). MATERIAL AND METHODS: This is a prospective randomized study conducted at NGMC, Nepalgunj, Nepal (2003-2004) on the patient attending for the treatment of intra-abdominal sepsis. Patients included in this study were of inflammation, obstruction with or without gangrene and perforation of appendix, small bowel and large bowel with localized or generalized peritonitis. These patients were managed surgically by- appendicectomy, closure of perforation, resection and anastomosis (R & A) and resection and proximal colostomy. Patients of large bowel obstruction without gangrene and small bowel gangrene were managed by R & A. These patients had significant faecal spillage at the surgical site as well as in the peritoneum. At the end of operation peritoneum and surgical site of all cases were washed with saline and povidone-iodine solution. They were put on one of the two protocols for post-operative treatment. A total 59 patients were included in this study. 32 cases were treated with protocol- A and rest 27 cases were treated with protocol- B. These cases were selected randomly for this study. Their outcome was compiled and compared under following headings: postoperative recovery, postoperative pyrexia, wound infection and dehiscence, anastomotic leak, residual abscess and cost of therapy. STATISTICAL ANALYSIS: Statistical analysis was done with the help of Chi square test. RESULT: Of the 59 patients, 32 were randomized to group I, 27 to group II. These groups were comparable in age, weight, sex and duration of therapy. Uneventful recovery was noted in 87.5 % (28/32) in -group I where as in 70.37% (19 /27) in-group II. Complications were observed in 12.5% in-group I where as 29.63 % in-group II. 10 patients in-group I where as 7 patients in -group II had surgical site infections (SSIs). All of these had superficial wound infection with/or without dehiscence of small portion of wound. A single case of residual abscess and anastomotic leak was observed. Postoperative pyrexia was noted in 8 patients in-group I where as in 6 patients in-group II. In pyrexia, temperature ranged from 99-104 0F. Finally except one case, rest of the cases recovered. On follow up after 3weeks, the cases recovered were doing well. CONCLUSION: At least three conclusions can be drawn from this study. Firstly protocol A is equally effective as protocol B. Secondly; it appears that combining aminoglycoside with Ceftriaxone therapeutically has no significant (P = 0.09) benefit over Ceftriaxone alone. Finally protocol A is less expensive in terms of total therapy than protocol B and can be used without fear even in subnormal functioning kidney.

Dexamethasone therapy for bacterial meningitis in adults: a double blind placebo control study.

Routine use of steroids in the treatment of bacterial meningitis remains controversial. A prospective placebo controlled double blind study of dexamethasone was carried out in 40 patients (age>10 years) of acute bacterial meningitis. The patients were randomly assigned to receive either placebo (n=20) or dexamethasone (n=20) in addition to injection ceftriaxone 100 mg/kg/day (maximum 4 gm/day) for 14 days. Dexamethasone sodium phosphate was given in dose of 0.6 mg/kg/day in 4 divided doses, for first 4 days of therapy. First dose of dexamethasone was given 15 minutes prior to first dose of ceftriaxone. Baseline demographics, clinical and laboratory features of the two groups were similar. Clinical improvement of signs of meningeal irritation was rapid in dexamethasone group than in the placebo group, but no significant difference was observed regarding resolution of fever, headache and vomiting. Secondary fever (mean+/-SD 15.00), gastrointestinal tract bleeding (mean+/-SD 15.00) and psychiatric manifestations (mean+/-SD 10.00) were more common in dexamethasone group. Neurological complications and hearing loss were more common and severe in placebo group as compared to the dexamethasone group (p<0.05). It is concluded that dexamethasone may be beneficial in some aspects of bacterial meningitis, in adults. A study with a larger number of cases in each group is recommended.

Avaliaçäo da acurácia do teste de adiçäo de clavulanato em disco para a detecçäo de amostras de Klebsiella Pneumoniae produtoras de ß-lactamases de espectro ampliado (ESBL) / Accuracy of the clavulanate disk addition (CDA) test to detect extended-spectrum ß-lactamases (ESBL) producing Klebsiella Pneumoniae

As ß-lactamases de espectro ampliado (extended-spectrum ß-lactamases - ESBL) têm sido detectadas com frequencia crescente em enterobactérias, particularmente em Klebsiella pneumoniae. Essas enzimas säo capazes de hidrolisar cefalosporinas de amplo espectro, monobactâmicos e penicilinas de amplo espectro; porém, säo inibidas por inibidores de ß-lactamases, tais como clavulanato, sulbactam e tazobactam. A grande variaçäo tanto no espectro dessa ß-lactomases quanto na velocidade com que elas degradam os diferentes B-lactâmicos faz com que a padronizaçäo de um teste de sensibilidade para detecçäo de cepas produtoras de ESBL seja muito difícil. O objetivo deste estudo foi avaliar a acurácia de um teste de sensibilidade em detectar cepas produtoras dessa enzimas. Foram avalidos 100 isolados clínicos de K. penumoniae. As amostras foram classificadas em produtoras ou näo-produtoras de ESBL, utlizando-se a fita Etest ESBL (ABBiodisk, Solna, Suécia). Uma reduçäo >-2,5 diluiçöes logarítmicas foi itulizada como critério de positividade. Dez microgramas de clavulanato foram adicionados a discos de 30µg de ceftazidima, cefuroxima, cefotaxima, ceftriaxona e aztreonam. A produçäo de ESBL é indicada por um aumento no halo de inibiçäo dos discos contendo clavulanato, em comparaçäo com o halo do disco sem clavulanato. A sensibilidade e especificidade do teste foram calculadas para cada substrato (ß-lactâmico) e para diferentes valores de aumento do halo (4,5,6 e 7mm). Quarenta amostras foram consideradas produtoras de ESBL. A utilizaçäo do substrato ceftriaxona com o breakpoint de 6mm mostrou a melhor sensibilidade (97 por cento), enqunto que cefuroxina com o brakpoint de 7mm mostrou a melhor especificidade (93,3 por cento). Nossos resultados mostram que o teste de adiçäo de clavulanato é uma técnica útil e apresenta acurácia adequada para a detecçäo de amostras produtoras de ESBL em laboratórios de rotina

Cefuroxima vs. cefuroxima-rafampicina en el tratamiento del empiema pleural en niños

La monoterapia con cefuroxima (CEF), por su espectro antimicrobiano, representa una de la opciones antibióticas de esta patología. Con el objetivo de evaluar si la adición de rifampicina (RIF) mejora la evolución del EP, se realizó un estudio prospectivo en el que se incluye niños hopitalizados con el diagnóstico de EP. Los pacientes (psts) fueron distribuidos aleatoriamente en dos grupos, los que recibieron CEF (200 mg/kg/día)(n=32) o la combinación REF-RIF (20 mg/kg/día) (n=29). No hubo diferencias co respecto a la evolución preadmisión, antibioticoterapia previa y condición clínica al ingreso entre ambos grupos postratamientos, la fiebre persistío 5,4=3,2 días en el grupo CEF vs 4,8=3,4 días en el grupo CEF-RIF (NS). El promedio de duracióndel drenaje, la frecuencia de recolación de tubos, y el tiempo de estancia hospitalaria fue similar en ambos grupos. Sin embargo, 6 pts (31 por ciento) del grupo CEF-RIF no es superior a CEF como monterapia en le tratamiento de niñas con EP y que el uso de indiscriminado de RIF podría acompañarse de mayor frecuencia de infecciones nosocomiales

Eficacia y seguridad de la profilaxis en cirugía cardiovascular con tres esquemas terapéuticos / Efficacy and security of cardiovascular surgery prophylaxis with three therapeutic schemes

Introducción. La profilaxis con antibióticos en cirugía cardiovascular disminuye la frecuencia de infecciones postoperatorias. Objetivo. Evaluar la eficacia y seguridad de tres esquemas de antibióticos empleados en nuestro hospital en cirugía cardiaca. Pacientes y métodos. Se realizó un estudio prospectivo, longitudinal, aleatorio y parcialmente controlado en 89 pacientes adultos sometidos a cirugía cardiovascular, entre marzo y agosto de 1995. Los pacientes se dividieron en tres grupos según el tratamiento recibido: A-cefuroxima (28 pacientes), B-cefalotina (32 pacientes) y C-dicloxacillina más amikacina (29 pacientes). Resultados. No hubo diferencias significativas entre los tres grupos en relación a la edad, sexo, factores de riesgo, duración de la cirugía, complicaciones no infecciosas (durante y después del procedimiento quirúrgico) y tasa de mortalidad. Las infecciones globales, respiratorias y de las heridas quirúrgicas tuvieron una tasa más alta en el grupo B. Los días de estancia de la UCI fueron más prolongados en los grupos B y C (p<0.05). Conclusión. La cefuroxima es efectiva en la prevención de la infecciones postoperatorias en cirugía cardiaca

Cefuroxime en el tratamiento de niños con neumonia complicada / Cefuroxime in the treatment of the children with complicated pneumonia

En el presente trabajo comunicamos nuestra experiencia en el manejo de las neumonías complicadas con un régimen parenteral de cefuroxime. 25 niños, 16 varones y 9 hembras con una edad promedio de 18,7 meses conforman la serie; las manifestaciones clínicas principales fueron fiebre, tos y disnea, presentes en más del 90%de los casos. La patología fue más frecuente en el pulmón derecho y la complicación fue en 23 casos derrame pleural y en dos casos derrame pleural y en 2 casos absceso pulmonar. El cultivo del líquido pleural fue positivo en 14 casos (56%), aislándose en 6 de ellos Stretopcoccus pneumonle, en 4 Haemophilus influenzae, en 2 de ellos Staphylococcus aureus, en un caso se aisló Streptococcus viridans y en un caso Escherichia coli. Se colocó sonda de drenaje pleural simple sin succión en todos los casos y se administró cefuroxime endovenoso a razón de 100 mgrs x Kg/día fraccionado cada 8 horas y durante 10 días. Al finalizar el régimen obtuvimos curación en 22 pacientes (88%) y fracaso en el3 (12%); en 2 de éstos últimos hubo necesidad de practicar descorticación pleural. Ningún paciente falleció y la tolerancia fue excelente. Nosotros concluimos que la toracotomía temprana y la administración de cefuroxime en monoterapia es muy buena elección para el tratamiento de las neumonías complicadas de la infancia