Uso de antibióticos y lactancia materna / Breastfeeding and antiinfectious agents

Con frecuencia, la presencia de una infección o la administraciónde un tratamiento antibiótico en la madre que amamantason motivo de contraindicación o retirada de la lactanciamaterna. Son contados los tratamientos antiinfecciososincompatibles con la lactancia materna y, sin embargo, contraindicaro retirar una lactancia incrementa de forma significativael riesgo de morbi-mortalidad para el lactante amamantado.Por ello, es imprescindible que el profesional disponga delas herramientas adecuadas que permitan elegir el mejor tratamientocompatible con la lactancia materna. El presente trabajorevisa los conceptos básicos de farmacodinamia durante lalactancia y ofrece un listado alfabético de los principales fármacosantiinfecciosos disponibles en el mercado actual juntocon un código numérico que ordena el nivel de riesgo de cadafármaco para el lactante o la lactancia. Finalmente, se ofrecenlas fuentes bibliográficas y páginas Web a donde dirigirse paraampliar esta información. Con todo ello pretendemos ofreceral lector interesado una herramienta útil que permita evitarcasos de abandono innecesario de la lactancia materna inducidospor profesionales incorrectamente informados(AU)

Not infrequently an infection or an antibiotic treatmentneeded by a lactating mother leads to medical advice againstbreastfeeding. However, advising against breastfeeding increasesmorbi-mortality risk in the infant. Besides there are fewanti-infectious agents not compatible with breastfeeding, andin these cases, there is usually an alternative to treat the mother’sillness. Thus it is important for health professionals to beinformed of best sources where to look for the best treatmentfor the mother compatible with breastfeeding. This article offersthe reader a review of basic pharmacodynamics which influencedrug use in human lactation, an alphabetically orderedlist of available anti-infectious agents coded by numbers indicatingrisk level, and some web recommendations for the interestedreader. We hope to offer the interested reader a usefultool which may prevent some cases of physician led abandonmentof lactation(AU)

Coste social y asistencial de la gastroenteritis pediátrica por rotavirus en España / Cost of paediatric rotavirus gastroenteritis management

Introducción: La gastroenteritis pediátrica por rotavirus (GPR) afecta a prácticamente todos los niños de hasta 5 años de edad, lo que conlleva un elevado porcentaje de hospitalizaciones y una gran morbilidad infantil. Pacientes y métodos: Se llevó a cabo un estudio de los costes de la enfermedad a partir de datos epidemiológicos y del uso de recursos en 252 niños con GPR atendidos en el ambulatorio, el servicio de urgencias o el hospital. Para ello se utilizó un cuestionario y diversas bases de datos de costes unitarios. Se estimó el coste por episodio de GPR y para una cohorte de 1.000 pacientes en cada nivel asistencial, considerando los costes directos sanitarios, los costes directos no sanitarios y los costes indirectos desde las perspectivas del Sistema Nacional de Salud (SNS) y de la sociedad. Resultados: Desde la perspectiva de la sociedad, el coste de tratar un episodio de GPR es de 1.551,7 € en el nivel hospitalario, de 408,9 € en urgencias y de 165,9 € en atención primaria. Los costes médicos directos suponen el 81,4% del coste total en el nivel hospitalario y el 53,8% en urgencias, mientras que en atención primaria la pérdida de productividad provoca el 75,3%del gasto total. Conclusiones: La GPR genera un uso considerable de recursos y costes sustanciales desde las perspectivas del SNS y de la sociedad. La prevención efectiva de la GPR a través de un sistema de inmunización infantil podría comportar ahorros importantes para el SNS y la sociedad en general (AU)

Title: Cost of paediatric rotavirus gastroenteritis management in Spain Introduction: Pediatric rotavirus gastroenteritis (RVGE) affects nearly all infants by five years of age, and accounts for a high number of hospitalizations. Patients and methods: A study was conducted in order to assess the costs of the disease in Spain, based on epidemiological data and the use of resources needed for the treatment of 252 children with RVGE attended at primary care, emergency room or hospital settings. A questionnaire was used as well as information on unitary costs. The costs of the disease where calculated per person and for a cohort of 1,000 patients in each level, taking into account direct medical costs, non medical direct costs and indirect costs from the National Health System(NHS) and societal perspectives. Results: From the societal perspective, RVGE has a cost per case of 1,551.7€, 408.9 € and 165.9 € when attended at the hospital, emergency room or primary care settings, respectively. Direct medical costs represent the largest part of the total costs at the Hospital (81.4%) and at the emergency room (53.8%), while at primary care, indirect costs due to loss of productivity are 75.3% of the expenditure. Conclusions: RVGE results in considerable resource utilization in all healthcare settings and substantial costs from NHS and society perspectives. Effective prevention of RVGE, through universal immunisation of infants, could result in substantial savings for both the NHS and the society (AU)

[Breastfeeding and antiinfectious agents]. / Uso de antibióticos y lactancia materna.

Not infrequently an infection or an antibiotic treatment needed by a lactating mother leads to medical advice against breastfeeding. However, advising against breastfeeding increases morbi-mortality risk in the infant. Besides there are few anti-infectious agents not compatible with breastfeeding, and in these cases, there is usually an alternative to treat the mother's illness. Thus it is important for health professionals to be informed of best sources where to look for the best treatment for the mother compatible with breastfeeding. This article offers the reader a review of basic pharmacodynamics which influence drug use in human lactation, an alphabetically ordered list of available anti-infectious agents coded by numbers indicating risk level, and some web recommendations for the interested reader. We hope to offer the interested reader a useful tool which may prevent some cases of physician led abandonment of lactation.

Migraña y mujer / Migraine and female

No disponible

Medicamentos, plantas, tóxicos, enfermedades y lactancia: una ayuda en español en Internet / Drugs, plants, toxins, diseases and breastfeeding: ana aid in Spanish on the Internet

Los beneficios de la lactancia materna, para el niño y la madre, su familia, el sistema sanitario y la sociedad en general, están muy bien documentados en múltiples publicaciones. Suprimir una lactancia sin un motivo de peso es una grave irresponsabilidad desde el punto de vista sanitario. Más del 90% de las mujeres pueden tener que tomar medicamentos o productos de fitoterapia durante el periodo de lactancia, lo que constituye un motivo clásico de cese de la lactancia, pese a no estar demostrado su peligro real más que en un pequeñísimo porcentaje de productos: fenindiona, amiodarona, derivados del ergot, antineoplásicos, y oduros y psicodrogas de abuso. Del mismo modo, sólo 6 enfermedades de la madre contraindican o hacen prácticamente imposible la lactancia. Con sentido común, unos conocimientos básicos de farmacología y pediatría y buenas guías (libros, revistas y páginas web), podemos asesorar a las mujeres que lactan, deben tomar remedios para alguna dolencia o sufren una enfermedad. Las madres huirán de informaciones erróneas, basadas sólo en prejuicios o en el Vademécum. Una página web(www.e-lactancia.org), en español y de sencillo manejo, nos ayudará a tomar decisiones acertadas antemás de 1.400 opciones diferentes implicadas en la lactancia materna

The benefits of breast feedingf or the infant, the mother, the family, the health care system and society in general are well documented in numerous scientific publications. The medical advice for weaning a child without a justified reason is an act of irresponsibility from an ethical point of view. Moret han 90% of women might need to take some type of medication while breastfeeding their babies at any time, this being a commonly alleged reason for weaning. However, only a few drugs have been shown to represent a real hazard: phenindione, amiodarone, ergot derivatives, antineoplastic agents, iodides and drugs of abuse. Seemingly, only six maternal diseases are considered to contraindicate breast feeding or make it nearly impossible. By exercising common sense, applying basic knowledge of Pharmacology and Pediatrics and using up dated guidelines (e.g. books, journals and web resources), we should be able to adequately advise those lactating mothers who require medication. Therefore, healthcare givers are committed to offering them proper assistance since mothers will ultimately reject misin formation or recommendations based on prejudice so rreleased by the industry, like that contained in the Physician's Desk Reference. A website, www.e-lactancia.org, an easy-touse resource in both Spanish and English, will help us make appropriate decisions concerning more than 1.400 options that a lactating mother may have to confront

[Iatrogenic botulism: a complication to be taken into account in the treatment of child spasticity]. / Botulismo yatrógeno: una complicación a tener en cuenta en el tratamiento de la espasticidad en la infancia.

INTRODUCTION: During the last decades the use of botulinum toxin for management of muscular disorders and spasticity associated to cerebral palsy has become a widespread practice. CASE REPORT: A 6-years female suffering of cerebral palsy secondary to a partial agenesis of the corpus callosum who was receiving bolulinum toxin since October 2001. One week after the last dose (Dysport 46 U/kg/dose) she started high grade fever, malaise, food refusal, choking, constipation, eyelid ptosis, absence of deep tendon reflexes, and abundant mucous discharge. Such features were so progressively severe that ventilatory support became mandatory. After a previous dose five months before, she developed similar features but they were less severe and thought to be related to a respiratory infection. CONCLUSIONS: At the present, there are two forms of botulinum toxin commercially available: the British brand Dysport and the American brand Botox. Bio equivalences are 1 U Botox to 2 or 6 U Dysport. Dosing (U/kg per session) has been established as follows: 5 U for Botox, 35 U for Dysport. Safety limits are a wide range with a therapeutic toxic index rate of 1:10. Generalized side effects after diffusion to blood of locally injected botulinum toxin are rare.

Botulismo yatrógeno: una complicación a tener en cuenta en el tratamiento de la espasticidad en la infancia / Iatrogenic botulism: a complication to be taken into account in the treatment of child spasticity

Introducción. En las últimas décadas se ha generalizado la terapia con toxina botulínica para el tratamiento de diferentes trastornos musculares, así como de la espasticidad asociada a parálisis infantil. Caso clínico. Niña de 6 años diagnosticada de parálisis cerebral secundaria a agenesia parcial de cuerpo calloso, que recibía tratamiento con toxina botulínica desde octubre de 2001. A la semana de recibir la última dosis de Dysport (46 U/kg/dosis) inició un cuadro de fiebre alta, decaimiento, rechazo del alimento, crisis de atragantamiento, estreñimiento, ptosis palpebral, ausencia de reflejos osteotendinosos y mucosidad abundante, todo ello progresivo, que obligó a aplicar medidas de soporte ventilatorio. En la dosis que recibió cinco meses antes presentó un cuadro de características clínicas similares pero de menor intensidad, que se atribuyó a un proceso infeccioso respiratorio. Conclusiones. Actualmente, hay dos tipos de toxina botulínica comercializada, la británica Dysport y la estadounidense Botox; la bioequivalencia clínica de 1 U de Botox es de 2 a 6 U de Dysport, y las dosis habituales máximas (U/kg por sesión) son de 5 U unidades para Botox y 35 U para Dysport. Los límites de seguridad son amplios, con una relación dosis terapéutica y tóxica de 1:10. Los efectos secundarios generalizados debidos a la difusión de la toxina a la sangre son raros (AU)

Introduction. During the last decades the use of botulinum toxin for management of muscular disorders and spasticity associated to cerebral palsy has become a widespread practice. Case report. A 6-years female suffering of cerebral palsy secondary to a partial agenesis of the corpus callosum who was receiving bolulinum toxin since October 2001. One week after the last dose (Dysport 46 U/kg/dose) she started high-grade fever, malaise, food refusal, choking, constipation, eyelid ptosis, absence of deep tendon reflexes, and abundant mucous discharge. Such features were so progressively severe that ventilatory support became mandatory. After a previous dose five months before, she developed similar features but they were less severe and thought to be related to a respiratory infection. Conclusions. At the present, there are two forms of botulinum toxin commercially available: the British brand Dysport and the American brand Botox. Bio-equivalences are 1 U Botox to 2 or 6 U Dysport. Dosing (U/kg per session) has been established as follows: 5 U for Botox, 35 U for Dysport. Safety limits are a wide range with a therapeutic-toxic index rate of 1:10. Generalized side effects after diffusion to blood of locally injected botulinum toxin are rare (AU)

[Breast feeding: knowledge, attitudes and sociocultural ambiguity]. / Lactancia materna: conocimientos, actitudes y ambigüedad sociocultural.

OBJECTIVES: Found sociocultural attitude with regard to breast-feeding (BF) between the sanitary (SP) and no sanitary personnel (NSP) of health centers. DESIGN: Descriptive, cross-sectional study. SETTING: 4 health centres and 3 hospitals of Valencia. PARTICIPANTS: 442 workers of these centres. INTERVENTION: Structured questionnaire. MAIN RESULTS: 88% of SP and 76% of NSP (p < 0.05) believed that BF has many advantages comparing with artificial-feeding in a developed country. SP said more advantages of BF than NSP (p < 0.0001). Most renowned advantages were immunological, affective relationship and comfort. Main inconveniences were dependence, work reasons, aesthetic nature and insecurity in the ingested amount. 56% of SP and 86% of NSP (p < 0.0001) believed milk's analysis necessary. 56% women and 38% men (p < 0.001) didn't see correct give BF in public. Men were more concerned than women (p < 0.05) for local problems of chest, aesthetic results, milk's quality and transmission of illnesses. CONCLUSIONS: It's necessary to support knowledge and re-evaluating the trust in the nutritious capacity of maternal milk between the personnel of health centers and hospitals. Generic ambiguity toward functions of feminine breast exists and public'BF isn't acceptable. It's necessary recover socioculturally the image of BF and keep in mind the existent ambiguity upon designing campaigns of promotion.