Prevalence of mutations associated with macrolide and fluoroquinolone resistance in Neisseria gonorrhoeae with Allplex™ NG&DR Assay (Seegene®) in a tertiary hospital from Madrid, Spaina / Prevalencia de mutaciones asociadas a resistencia a macrólidos y fluoroquinolonas en Neisseria gonorrhoeae con el kit Allplex™ NG&DR Assay (Seegene®) en un hospital terciario de la Comunidad de Madrid, España

Background. The prevalence of drug-resistant Neisseria gonorrhoeae (NG) infections is increasing. Studies report the prevalence of NG strains presenting A2059G/C2611T (rRNA 23S) and S91F (parC) mutations conferring resistance to azith romycin and ciprofloxacin. Material and methods. We conducted a prospective cohort study evaluating first void-urine urines, rectal, and oropharyngeal swabs collected from a cohort of patients in a tertiary hospital in Madrid between October 2022 and January 2023. Samples were screened by Allplex™ 7-STI Essential As say (Seegene®). Drug resistances were performed by Allplex™ NG&DR Assay (Seegene®). Results. A total of 1,415 patients were included, of which 112 had a positive sample for NG infection. One patient had a C2611T mutation (0.9%) and neither patient showed A2059G mutation. We found 67 (59.8%) S91F-positive patients. For ty-four patients (39.3%) not had any mutations. Conclusions. We report a low-prevalence of mutations A2059G/C2611T to macrolides and a high-prevalence to S91F in NG infections. Molecular methods for the detection of NG resistance could be useful in direct non-culturable samples (AU)

Introducción. La infección por Neisseria gonorrhoeae (NG) resistente está aumentando. Se ha descrito la prevalencia de cepas de NG con mutaciones A2059G/C2611T (rRNA 23S) y S91F (parC) que confieren resistencia a azitromicina y cipro floxacino. Material y métodos. Realizamos un estudio prospecti vo evaluando orinas de primera micción, hisopos anales y fa ríngeos recogidos de una cohorte de pacientes en un hospital terciario de Madrid entre octubre de 2022 y enero de 2023. El cribado de las muestras se realizó mediante Allplex™ 7-STI Es sential Assay (Seegene®). Las resistencias a macrólidos y fluo roquinolonas se realizaron mediante Allplex™ NG&DR Assay (Seegene®). Resultados. Se incluyeron 1.415 pacientes, de los cua les 112 fueron positivos para NG. Un paciente presentaba una mutación C2611T (0,9%) y en ningún paciente se detec tó A2059G. Encontramos 67 pacientes (59,8%) positivos pa ra S91F. Cuarenta y cuatro pacientes (39,3%) no presentaban mutaciones. Conclusiones. Reportamos una baja prevalencia de mu taciones A2059G/C2611T a macrólidos y una alta prevalencia de S91F en NG. Los métodos moleculares para la detección de resistencias en NG podrían ser útiles en muestras directas no cultivables (AU)

Efectividad del tratamiento con ciprofloxacino durante 21 días en la primoinfección por pseudomonas aeruginosa en las bronquiectasias no fibrosis quística / Effectiveness of treatment with ciprofloxacin during 21 days in primoinfection by pseudomonas aeruginosa in the bronchiectasia not cystic fibrosis

Las bronquiectasias no debidas a fibrosis quística (FQ) constituyen la tercera patología inflamatoria crónica más frecuente de las vías respiratorias.La infección bronquial determina la progresión de la enfermedad, siendo la infección por Pseudomonas aeruginosa la que se asocia con peor pronóstico. Por este motivo, las guías de práctica clínica recomiendan la erradicación de P. aeruginosa en la infección primaria. Hasta el momento ningún estudio ha demostrado la utilidad real de esta pauta de tratamiento en el manejo de la infección bronquial inicial por Pseudomonas aeruginosa, por lo que el objetivo de este estudio es determinar la efectividad del tratamiento con Ciprofloxacino 750 mg cada 12 horas por vía oral durante 21 días en la erradicación de P. aeruginosa en pacientes con bronquiectasias no relacionadas con FQ. (AU)

Bronchiectasis not due to cystic fibrosis (CF) constitutes the third most frequent chronic inflammatory pathology of the airways. Bronchial infection determines the progression of the disease, being infection by Pseudomonas aeruginosa the one that is associated with the worst prognosis. For this reason, clinical practice guidelinesrecommend eradication of P. aeruginosa in primary infection. At the moment, any study has shown the real usefulness of this treatment regimen in the management of the initial bronchial infection by Pseudomonas aeruginosa, so the objective of this study is to determine the effectiveness of treatment with Ciprofloxacin 750 mg every 12 hours orally for 21 days in the eradication of P. aeruginosa in patients with non-CF bronchiectasis. (AU)

Outbreak of Arcobacter butzleri? An emerging enteropathogen.

BACKGROUND: Arcobacter butzleri is a gram-negative rod, with microaerobic growth at an optimal temperature of 37°C. It was reported to be the fourth most common Campylobacter-like organism isolated from patients with diarrhoea. OBJECTIVE: Characterise a potential outbreak of A. butzleri detected in a short period of time in the University Hospital Marqués de Valdecilla. METHODS: Eight strains of A. butzleri were detected in our hospital in only two months. Isolates were identified by MALDI-TOF MS system and 16S rDNA sequencing. Enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) and Pulsed Field Gel Electrophoresis (PFGE) were carried out to assess clonal relationship. Gradient strips (Etest) were used to determine susceptibility by agar diffusion. RESULTS: ERIC-PCR and PFGE confirmed the lack of clonal relationship between strains. Erythromycin or ciprofloxacin might be appropriate for antibiotic treatment of infections. CONCLUSIONS: A. butzleri is an emerging pathogen with increasing incidence, and may be underestimated.

Outbreak of Arcobacter butzleri? An emerging enteropathogen / Brote de Arcobacter butzleri? Un enteropatógeno emergente

Background: Arcobacter butzleri is a gram-negative rod, with microaerobic growth at an optimal temperature of 37°C. It was reported to be the fourth most common Campylobacter-like organism isolated from patients with diarrhoea. Objective: Characterise a potential outbreak of A. butzleri detected in a short period of time in the University Hospital Marqués de Valdecilla. Methods: Eight strains of A. butzleri were detected in our hospital in only two months. Isolates were identified by MALDI-TOF MS system and 16S rDNA sequencing. Enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) and Pulsed Field Gel Electrophoresis (PFGE) were carried out to assess clonal relationship. Gradient strips (Etest) were used to determine susceptibility by agar diffusion. Results: ERIC-PCR and PFGE confirmed the lack of clonal relationship between strains. Erythromycin or ciprofloxacin might be appropriate for antibiotic treatment of infections. Conclusions: A. butzleri is an emerging pathogen with increasing incidence, and may be underestimated.(AU)

Antecedentes: Arcobacter butzleri es un bacilo gramnegativo, con crecimiento microaerófilo a una temperatura óptima de 37°C. Ha sido descrito como el cuarto organismo asociado a Campylobacter más frecuentemente aislado de pacientes con diarrea. Objetivo: Caracterizar un potencial brote de A. butzleri detectado en el Hospital Universitario Marqués de Valdecilla. Métodos: Se detectaron 8 cepas de A. butzleri en nuestro hospital en solo 2 meses. Los aislamientos fueron identificados con MALDI-TOF MS y secuenciación del ARNr 16S. Se llevó a cabo la PCR basada en secuencia de consenso intergénica repetitiva de enterobacterias(ERIC-PCR) y electroforesis en campo pulsado (PFGE) para asegurar la relación clonal. Para determinar la sensibilidad se usaron tiras de gradiente (Etest®) por difusión en agar. Resultados: ERIC-PCR y PFGE confirmaron la falta de relación clonal entre las cepas. Eritromicina o ciprofloxacino podrían ser apropiados para el tratamiento antibiótico de estas infecciones. Conclusiones: A. butzleri es un patógeno emergente con un aumento en la incidencia, y podría estar subestimado.(AU)

Rotura del tendón de Aquiles asociada al uso de fluoroquinolonas en pacientes mayores de 60 años: experiencia de un centro de tercer nivel / Achilles Tendon Rupture Associated with the Use of Fluoroquinolones in Patients Over 60 Years of AGE: Experience From a Single Tertiary Centre

Introducción: Las fluoroquinolonas han sido asociadas con aumento del riesgo de tendinopatía y rotura del tendón de Aquiles (RTA), especialmente en pacientes mayores de 60 años. Métodos: Se llevó a cabo un estudio retrospectivo en el que se incluyó a los pacientes mayores de 60 años con RTA atendidos en nuestro centro durante el período 2000-2017. Resultados: Se identificó a 44 pacientes con RTA, de los cuales 18% (8/44) habían sido tratados previamente con fluoroquinolonas, con una media de edad al diagnóstico de RTA de 77,37 años y corticoterapia concomitante en 4 de ellos. En 7 pacientes la rotura fue espontánea y todas requirieron tratamiento quirúrgico. Se encontró una frecuencia significativamente mayor de tabaquismo, corticoterapia concomitante y roturas espontáneas en el grupo tratado con fluoroquinolonas. Conclusiones: La RTA es un evento adverso que puede ocurrir en pacientes mayores de 60 años tratados con fluoroquinolonas, por lo que debería realizarse una adecuada evaluación relación riesgo-beneficio en esta población, especialmente en presencia de factores de riesgo asociados.(AU)

Background: Fluoroquinolones have been associated with increased risk of tendinopathy and Achilles tendon rupture (ATR), especially in patients over 60 years of age.Methods: A retrospective study was carried out including patients over 60 years of age with ATR attended in our centre over the period 2000-2017. Results: We identified 44 patients with RTA, of whom 18% (8/44) had been previously treated with fluoroquinolones, with a mean age at diagnosis of ATR of 77.37 years and concomitant corticotherapy in 4 of them. In 7patients, the rupture was spontaneous and all required surgical management. A significantly higher frequency of smoking, concomitant corticotherapy and spontaneous ruptures were found in the group treated with fluoroquinolones. Conclusions: ATR is an adverse event that can occur in patients over 60 years of age treated with fluoroquinolones, so an adequate risk-benefit assessment should be carried out in this population, especially in the presence of associated risk factors.(AU)

Achilles Tendon Rupture Associated with the Use of Fluoroquinolones in Patients Over 60 Years of AGE: Experience From a Single Tertiary Centre. / Rotura del tendón de Aquiles asociada al uso de fluoroquinolonas en pacientes mayores de 60 años: experiencia de un centro de tercer nivel.

BACKGROUND: Fluoroquinolones have been associated with increased risk of tendinopathy and Achilles tendon rupture (ATR), especially in patients over 60 years of age. METHODS: A retrospective study was carried out including patients over 60 years of age with ATR attended in our centre over the period 2000-2017. RESULTS: We identified 44 patients with RTA, of whom 18% (8/44) had been previously treated with fluoroquinolones, with a mean age at diagnosis of ATR of 77.37 years and concomitant corticotherapy in 4 of them. In 7patients, the rupture was spontaneous and all required surgical management. A significantly higher frequency of smoking, concomitant corticotherapy and spontaneous ruptures were found in the group treated with fluoroquinolones. CONCLUSIONS: ATR is an adverse event that can occur in patients over 60 years of age treated with fluoroquinolones, so an adequate risk-benefit assessment should be carried out in this population, especially in the presence of associated risk factors.

Impact of urinary selective antibiogram in primary care / Impacto do antibiograma seletivo nas uroculturas em cuidados primários

ABSTRACT INTRODUCTION: Selective reporting of antibiotic susceptibility test results (selective antibiogram), is increasingly recognized as one of the key strategies of antibiotic stewardship programs. The objective of this study is to determine the impact of selective susceptibility reporting on ciprofloxacin utilization and Escherichia coli susceptibility to ciprofloxacin in the outpatient setting. MATERIAL AND METHODS: A selective reporting policy was created and implemented in 2011. The policy involves the non-reporting of ciprofloxacin susceptibility to Enterobacteriaceae isolated in a urine sample when there was susceptibility to other agents with narrow spectrum. The outcomes evaluated were outpatient ciprofloxacin utilization and E. coli susceptibility to ciprofloxacin between January 2011 and December 2018 RESULTS: Between 2011 and 2018 we detected an increased susceptibility rate of E. coli to ciprofloxacin from 79% to 87% (p < 0.001) and a decreased incidence rate of E. coli resistant to ciprofloxacin from 2.52 to 0.87 (p < 0.001). The ciprofloxacin dropped from 0.75 defined daily doses (DHD) to 0.36 DHD and there was a compensatory increase in nitrofurantoin and fosfomycin utilization. DISCUSSION: Our study showed that selective reporting can influence prescribing practice in a community level and encourages clinicians to select more narrow-spectrum and cost-effective antimicrobial agents in UTIs. CONCLUSION: Our results suggest that selective antibiogram should be considered an effective prevention strategy to reduce targeted antimicrobial utilization.

RESUMEN INTRODUCCIÓN: La notificación selectiva de resultados de la prueba de susceptibilidad bacteriana (antibiograma selectivo) es conocida como una de las estrategias clave de los programas de optimización de antimicrobianos. El objetivo de este estudio fue determinar el impacto del antibiograma selectivo en el consumo de ciprofloxacino y la sensibilidad de la bacteria Escherichia coli al ciprofloxacino en la atención básica. MATERIAL Y MÉTODOS: La política de informe selectivo fue creada e implementada en 2011 e incluyó la no trasmisión, en el antibiograma, de sensibilidad de Enterobacteriaceae al ciprofloxacino en muestras urinarias cuando había sensibilidad a otros agentes de espectro reducido. Los desenlaces evaluados fueron el consumo de ciprofloxacino y la evolución de sensibilidad de E. coli al ciprofloxacino entre enero de 2011 y diciembre de 2018. RESULTADOS En esse período, se detectó un aumento en la tasa de sensibilidad de E. coli al ciprofloxacino, del 79% al 87% (p < 0,001). La tasa de incidencia de E. coli resistente al ciprofloxacino descendió de 2,52 a 0,87 (p < 0,001). El consumo de ciprofloxacino tuvo un descenso de 0,75 doses por mil habitantes día (DHD) a 0,36 DHD. Al mismo tiempo, un aumento compensatorio se observó en el consumo de nitrofurantoína y fosfomicina. DISCUSIÓN: Nuestro estudio demostró que el uso del antibiograma selectivo influyó en la práctica de prescripción de antimicrobianos y animó a los médicos generales a elegir antimicrobianos de espectro más reducido y con mejor relación de costo-beneficio. CONCLUSIÓN: Nuestros resultados sugieren que la utilización de antibiogramas selectivos debe ser considerada una estrategia efectiva en la reducción del consumo de determinados antimicrobianos.

RESUMO INTRODUÇÃO: A notificação seletiva dos resultados do teste de suscetibilidade aos antimicrobianos (antibiograma seletivo) é conhecida como uma das estratégias-chave dos programas de apoio à prescrição de antibióticos. O objetivo deste estudo foi determinar o impacto do antibiograma seletivo no consumo de ciprofloxacino e a suscetibilidade da bactéria Escherichia coli ao ciprofloxacino nos cuidados primários. MATERIAL E MÉTODOS: A política de notificação seletiva foi criada e implementada em 2011 e envolveu a não transmissão, no antibiograma, da suscetibilidade da família Enterobacteriaceae ao ciprofloxacino em amostras urinárias quando existia suscetibilidade a outros agentes com menor espectro. Os desfechos avaliados foram consumo de ciprofloxacino e evolução da suscetibilidade de E. coli ao ciprofloxacino entre janeiro de 2011 e dezembro de 2018. RESULTADOS: Nesse período, um aumento foi detectado na taxa de suscetibilidade de E. coli ao ciprofloxacino, de 79% a 87% (p < 0,001). A taxa de incidência de E. coli resistente ao ciprofloxacino diminuiu de 2,52 para 0,87 (p < 0,001). O consumo de ciprofloxacino teve uma queda de 0,75 doses diárias definidas (DHD) para 0,36 DHD. Simultaneamente, um aumento compensatório foi observado no consumo de nitrofurantoína e fosfomicina. DISCUSSÃO: Nosso estudo demonstrou que a utilização do antibiograma seletivo influenciou a prática de prescrição dos antimicrobianos e incentivou os clínicos gerais a selecionar antimicrobianos de espectro de ação mais reduzido e com melhor relação custo-benefício. CONCLUSÃO: Nossos resultados sugerem que a utilização de antibiogramas seletivos deve ser considerada uma estratégia eficaz na redução do consumo de determinados antimicrobianos.

Carbapenems versus ciprofloxacin/metronidazole for decreasing complications and hospital stay following complicated acute appendicitis surgery: A prospective cohort in an Ecuadorian population.

BACKGROUND: After appendectomy due to complicated acute appendicitis (CAA), there are some alternatives as antibiotic scheme: ciprofloxacin/metronidazole; as well as monoscheme based on carbapenems: ertapenem, meropenem, and imipenem. AIM: This study aims to prove the efficacy of carbapenems versus ciprofloxacin/metronidazole in CAA post-operative management in terms of preventing complications during post-operative period and decreasing hospital stay. MATERIALS AND METHODS: This was an observational, analytical, longitudinal, and prospective cohort study (March 2014-November 2016). Patients were classified into two groups, according to the prescribed antibiotic scheme: some carbapenems or ciprofloxacin/metronidazole. RESULTS: Ninety-eight patients were enrolled. There was an requirement for antibiotic therapy rotation only in the ciprofloxacin/metronidazole (7/49, 14.3%; p = 0.004). Carbapenems reached a mean hospital stay of 4.45 days, in contrast with ciprofloxacin/metronidazole, 8.29 days (p = 0.020). In post-surgical follow-up, there were more cases of curative resolution in the group in the carbapenems group (35/49 vs. 15/49 p < 0.001) as well as a greater number of cases with some late infection in the ciprofloxacin/metronidazole group (1/49 vs. 10/49, p = 0.010). CONCLUSION: In the post-operative management of CAA, carbapenems represent an important indication to be considered as first-line antibiotic therapy.

ANTECEDENTES: Tras la cirugía por apendicitis aguda complicada existen varias alternativas de esquema antibiótico, entre las que destacan ciprofloxacino/metronidazol, o bien monoterapia con algún carbapenémico, como ertapenem, meropenem e imipenem. OBJETIVO: Determinar la eficacia de los carbapenémicos en comparación con ciprofloxacino/metronidazol en el manejo posquirúrgico de la apendicitis aguda complicada, en términos de prevención de complicaciones durante el ­posoperatorio y de reducción de la estancia hospitalaria. MÉTODO: Estudio observacional, analítico, longitudinal, prospectivo y de cohorte, de marzo de 2014 a noviembre de 2016. Los pacientes fueron clasificados en dos grupos según el esquema antibiótico prescrito: un carbapenémico o ciprofloxacino/metronidazol. RESULTADOS: Se seleccionaron 98 pacientes. Solo hubo necesidad de rotación de antibiótico en el grupo de ciprofloxacino/metronidazol (7 de 49, 14.3%; p = 0.004). En el grupo de carbapenémico, la media de estancia hospitalaria fue de 4.45 días, y en el grupo de ciprofloxacino/metronidazol fue de 8.29 días (p = 0.020). En el seguimiento posquirúrgico hubo más casos de resolución curativa en el grupo de carbapenémico (35 de 49 vs. 15 de 49; p < 0.001), así como un mayor número de casos con alguna infección tardía en el grupo de ciprofloxacino/metronidazol (1 de 49 vs. 10 de 49; p < 0.001). CONCLUSIÓN: En el manejo posquirúrgico de la apendicitis aguda complicada, los carbapenémicos representan una importante indicación que debe considerarse como antibioticoterapia de primera línea.

Actualización en la prescripción de fluoroquinolonas / Update on the prescription of fluoroquinolones

Resumen: Las quinolonas o fluoroquinolonas son un grupo de antibióticos frecuentemente prescritos y de amplio espectro que actúan inhibiendo a las enzimas encargadas de la replicación, transcripción, reparación y recombinación del ADN bacteriano. El objetivo de este artículo es presentar una revisión sistemática de los antecedentes, farmacocinética y actividad microbiológica de las tres fluoroquinolonas más representativas en nuestro medio (ciprofloxacino, levofloxacino y moxifloxacino) en sus tres indicaciones actualmente autorizadas: infecciones de vías respiratorias inferiores, de vías urinarias, de piel y tejidos blandos.

Abstract: Quinolones or fluoroquinolones are a group of commonly prescribed and broad-spectrum antibiotics drugs that act by inhibiting the enzymes responsible for the bacterial DNA replication, transcription, repair and recombination. The aim of this article is to present a systematic review of the three most representative fluoroquinolones in our country (ciprofloxacin, levofloxacin and moxifloxacin) in their three authorized indications: lower respiratory tract infections, urinary tract infections, skin and soft tissues infections.

Rectal culture-directed antibiotic prophylaxis before transrectal prostate biopsy: Reduced infectious complications and healthcare costs. / Profilaxis antibiótica «dirigida¼ por cultivos rectales antes de la biopsia prostática transrectal: reducción de complicaciones infecciosas y costes de atención sanitaria.

BACKGROUND: Transrectal ultrasound-guided prostate biopsy (TUPB) is associated with infectious complications (ICs), which are related to a greater prevalence of ciprofloxacin-resistant bacteria (CRB) in rectal flora. We examined the ICs that occurred in 2 groups: A guided antibiotic prophylaxis (GP) group and an empiric prophylaxis (EP) group. We assessed the financial impact of GP. MATERIAL AND METHODS: The GP group was studied prospectively (June 2013 to July 2014). We collected rectal cultures (RCs) before the TUPB, which were seeded on selective media with ciprofloxacin to determine the presence of CRB. The patients with sensitive bacteria were administered ciprofloxacin. Patients with resistant bacteria were administered GP according to the RC antibiogram. The EP group was studied retrospectively (January 2011 to June 2009). RCs were not performed, and all patients were treated with ciprofloxacin as prophylaxis. The ICs in both groups were recorded during a period no longer than 30 days following TUPB (electronic medical history). RESULTS: Three hundred patients underwent TUPB, 145 underwent GP, and 155 underwent EP. In the GP group, 23 patients (15.86%) presented CRB in the RCs. Only one patient (0.7%) experienced a UTI. In the EP group, 26 patients (16.8%) experienced multiple ICs (including 2 cases of sepsis) (P<.005). The estimated total cost, including the management of the ICs, was €57,076 with EP versus €4802.33 with GP. The average cost per patient with EP was €368.23 versus €33.11 with GP. GP achieved an estimated total savings of €52,273.67. Six patients had to undergo GP to prevent an IC. CONCLUSIONS: GP is associated with a marked decrease in the incidence of ICs caused by CRB and reduced healthcare costs.

Prescripción de ciprofloxacino por vía parenteral en pacientes ingresados en los servicios de Medicina Interna y Caumatología de un hospital general / Parenteral prescription of ciprofloxacin in patients admitted to the Internal Medicine and Caumatology services of a general hospital

Se realizó un estudio observacional descriptivo y transversal de 76 pacientes ingresados en los servicios de Medicina Interna y Caumatología del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba durante el 2012, para evaluar los conocimientos, el desempeño y la satisfacción de 22 profesionales que prescribieron ciprofloxacino por vía parental. Los conocimientos y la satisfacción fueron evaluados a través de un examen de conocimientos y una encuesta de satisfacción, respectivamente; el desempeño, a partir de la información obtenida de las historias clínicas, relacionadas con tres criterios: individualización del tratamiento, esquema terapéutico y combinaciones medicamentosas. Para cada criterio se establecieron indicadores y estándares. Los prescriptores presentaron conocimientos adecuados sobre el medicamento en cuestión; sin embargo, el desempeño y la satisfacción de estos resultaron inadecuados. Se considera necesario realizar una intervención en aras de revertir las deficiencias identificadas y contribuir a elevar la calidad de la prescripción de medicamentos en ambos servicios de salud(AU)

A descriptive, cross-sectional and observational study of 76 patients admitted to the Internal Medicine and Caumatology services of Dr Juan Bruno Zayas Alfonso Teaching General Hospital was carried out in Santiago de Cuba during 2012, to evaluate the knowledge, performance and satisfaction of 22 professionals who prescribed parental ciprofloxacin. The knowledge and satisfaction were evaluated through a knowledge examination and a survey of satisfaction, respectively; the performance was evaluated, starting from the information obtained from the medical records, related to 3 criteria: individualization of the treatment, therapeutic schedule and medication combinations. For each opinion, indicators and standards were established. The prescribers presented appropriate knowledge on the specific medication; however, the performance and satisfaction of them were inadequate. It is necessary to carry out an intervention to revert the identified deficiencies and contribute to elevate the quality of the medications prescription in both health services(AU)

Prescripción de ciprofloxacino por vía parenteral en pacientes ingresados en los servicios de Medicina Interna y Caumatología de un hospital general / Parenteral prescription of ciprofloxacin in patients admitted to the Internal Medicine and Caumatology services of a general hospital

Se realizó un estudio observacional descriptivo y transversal de 76 pacientes ingresados en los servicios de Medicina Interna y Caumatología del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba durante el 2012, para evaluar los conocimientos, el desempeño y la satisfacción de 22 profesionales que prescribieron ciprofloxacino por vía parental. Los conocimientos y la satisfacción fueron evaluados a través de un examen de conocimientos y una encuesta de satisfacción, respectivamente; el desempeño, a partir de la información obtenida de las historias clínicas, relacionadas con tres criterios: individualización del tratamiento, esquema terapéutico y combinaciones medicamentosas. Para cada criterio se establecieron indicadores y estándares. Los prescriptores presentaron conocimientos adecuados sobre el medicamento en cuestión; sin embargo, el desempeño y la satisfacción de estos resultaron inadecuados. Se considera necesario realizar una intervención en aras de revertir las deficiencias identificadas y contribuir a elevar la calidad de la prescripción de medicamentos en ambos servicios de salud

A descriptive, cross-sectional and observational study of 76 patients admitted to the Internal Medicine and Caumatology services of Dr Juan Bruno Zayas Alfonso Teaching General Hospital was carried out in Santiago de Cuba during 2012, to evaluate the knowledge, performance and satisfaction of 22 professionals who prescribed parental ciprofloxacin. The knowledge and satisfaction were evaluated through a knowledge examination and a survey of satisfaction, respectively; the performance was evaluated, starting from the information obtained from the medical records, related to 3 criteria: individualization of the treatment, therapeutic schedule and medication combinations. For each opinion, indicators and standards were established. The prescribers presented appropriate knowledge on the specific medication; however, the performance and satisfaction of them were inadequate. It is necessary to carry out an intervention to revert the identified deficiencies and contribute to elevate the quality of the medications prescription in both health services

Caracterización clínica, epidemiológica y terapéutica de los pacientes con otitis externa maligna / Clinical, epidemiological and therapeutical characterization of patients with malignant external

Se realizó un estudio descriptivo de serie de casos, de 42 pacientes con otitis externa maligna, atendidos en el Servicio de Otorrinolaringología del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora de la provincia de Santiago de Cuba desde enero de 2002 hasta diciembre de 2014 y tratados básicamente con ciprofloxacina, a fin de caracterizarles clínica, epidemiológica y terapéuticamente, así como determinar su evolución clínica con el tratamiento indicado. También se incluyó un segundo grupo de 29 integrantes con la misma afección, quienes durante esos 12 años recibieron otros antibióticos y no la citada quinolona, tratados igualmente en dicho Servicio durante el período señalado. Entre los principales resultados sobresalió el predominio del grupo etario de 55-64 años (30,6 por ciento) en los que se utilizó ciprofloxacino y de 75 y más (74,8 por ciento) en los que se indicaron otros antimicrobianos; del tiempo de evolución de la diabetes mellitus de 0-10 años en 24 (57,1 por ciento) de quienes recibieron ciprofloxacino y en 14 (48,2 por ciento) de aquellos que no la consumieron y de la Pseudomonas aeruginosa como el germen más frecuentemente aislado. La evolución de los pacientes fue favorable, independientemente del tratamiento antimicrobiano prescrito, pero todos los tratados con ciprofloxacina egresaron en menos de 30 días mejorados o curados. Se concluyó que la edad avanzada favorece la aparición de la otitis externa maligna, sin importar el tiempo de evolución de la diabetes mellitus(AU)

A descriptive, serial cases study, of 42 patients with malignant external otitis was carried out. They were assisted in the Otolaryngology Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba from January, 2002 to December, 2014 and treated basically with ciprofloxacin, in order to characterize them clinical, epidemiological and therapeutically, as well as to determine their clinical course with the suitable treatment. A second group of 29 members with the same disorder was also included who received other antibiotics during those 12 years, treated in this Service during that period. Among the main results there was a prevalence of the 55-64 years age group (30.6 percent) in which ciprofloxacin was used and over 75 years (74.8 percent) in which other antimicrobians were indicated; of the time in the diabetes mellitus course 0-10 years in 24 (57.1 percent) of those who received ciprofloxacin and in 14 (48.2 percent) of those that didn't consume it and of the Pseudomonas aeruginosa as the most frequently isolated germ. The patients had a favorable clinical course, no matter the antimicrobian prescribed treatment, but all the patients treated with ciprofloxacin got better or were cured and were discharged in less than 30 days. It was concluded that the advanced age favors the emergence of the malignant external otitis, no matter the time of the diabetes mellitus course(AU)

Caracterización clínica, epidemiológica y terapéutica de los pacientes con otitis externa maligna / Clinical, epidemiological and therapeutical characterization of patients with malignant external

Se realizó un estudio descriptivo de serie de casos, de 42 pacientes con otitis externa maligna, atendidos en el Servicio de Otorrinolaringología del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora de la provincia de Santiago de Cuba desde enero de 2002 hasta diciembre de 2014 y tratados básicamente con ciprofloxacina, a fin de caracterizarles clínica, epidemiológica y terapéuticamente, así como determinar su evolución clínica con el tratamiento indicado. También se incluyó un segundo grupo de 29 integrantes con la misma afección, quienes durante esos 12 años recibieron otros antibióticos y no la citada quinolona, tratados igualmente en dicho Servicio durante el período señalado. Entre los principales resultados sobresalió el predominio del grupo etario de 55-64 años (30,6 por ciento) en los que se utilizó ciprofloxacino y de 75 y más (74,8 por ciento) en los que se indicaron otros antimicrobianos; del tiempo de evolución de la diabetes mellitus de 0-10 años en 24 (57,1 por ciento) de quienes recibieron ciprofloxacino y en 14 (48,2 por ciento) de aquellos que no la consumieron y de la Pseudomonas aeruginosa como el germen más frecuentemente aislado. La evolución de los pacientes fue favorable, independientemente del tratamiento antimicrobiano prescrito, pero todos los tratados con ciprofloxacina egresaron en menos de 30 días mejorados o curados. Se concluyó que la edad avanzada favorece la aparición de la otitis externa maligna, sin importar el tiempo de evolución de la diabetes mellitus

A descriptive, serial cases study, of 42 patients with malignant external otitis was carried out. They were assisted in the Otolaryngology Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba from January, 2002 to December, 2014 and treated basically with ciprofloxacin, in order to characterize them clinical, epidemiological and therapeutically, as well as to determine their clinical course with the suitable treatment. A second group of 29 members with the same disorder was also included who received other antibiotics during those 12 years, treated in this Service during that period. Among the main results there was a prevalence of the 55-64 years age group (30.6 percent) in which ciprofloxacin was used and over 75 years (74.8 percent) in which other antimicrobians were indicated; of the time in the diabetes mellitus course 0-10 years in 24 (57.1 percent) of those who received ciprofloxacin and in 14 (48.2 percent) of those that didn't consume it and of the Pseudomonas aeruginosa as the most frequently isolated germ. The patients had a favorable clinical course, no matter the antimicrobian prescribed treatment, but all the patients treated with ciprofloxacin got better or were cured and were discharged in less than 30 days. It was concluded that the advanced age favors the emergence of the malignant external otitis, no matter the time of the diabetes mellitus course

Evaluación de la resistencia a la erosión ácida de dos ionómeros de vidrio utilizados en la técnica restaurativa atraumática (TRA), modificados con un antibiótico / Evaluation of resistance to acid erosiion two glass ionomers used in the atraumatic restorative technique (art), modified with an antibiotic

En el presente estudio se evaluó la resistencia a la erosión ácida de dos ionómeros de vidrio de restauración, adicionados con ciprofloxacino al 2%, ya que la sinergia que tiene este con otras sustancias lo hace una sal adecuada para el estudio y puede ser utilizado en la técnica restaurativa atraumática.OBJETIVO: Evaluar la resistencia a la erosión ácida del ionómero de vidrio adicionado con ciprofloxacino al 2%, según los lineamientos de la norma 96 de la ADA.MATERIALES Y MÉTODOS: Se utilizaron dos marcas comerciales de ionómero de vidrio GC Gold Label 2® y KetacTM Molar Easymix®, conformando cuatro grupos: El grupo control que fueron los ionómeros de restauración convencionales, y el grupo de estudio al que se le adicionó ciprofloxacino al 2%. RESULTADOS: Fueron evaluados mediante el análisis de varianza ANOVA de una vía y se observó que en la comparación entre los dos grupos, no hubo diferencia estadísticamente significativa (p>0.005).CONCLUSIÓN: La adición del ciprofloxacino al 2% no altera la resistencia a la erosión ácida de los ionómeros de vidrio para restauración, y puede considerarse un material para ser utilizado en la técnica TRA en estudios posteriores. (AU)

In the present study the acid erosion resistance two glass ionomer restorative, ciprofloxacin added 2% was evaluated as having this synergy with other substances makes a suitable salt for the study and may be used in atraumatic restorative technique.OBJECTIVE: To evaluate the resistance to acid erosion glass ionomer added ciprofloxacin 2% to 2%, according to the guidelines of rule 96 of the ADA. MATERIALS AND METHODS: Two trademarks glass ionomer GC Gold Label 2® and KetacTM Molar Easymix® were used by forming two four groups: control group were conventional ionomer restoration, and the study group to which he was added 2% ciprofloxacin. Results: The results were evaluated by ANOVA one-way and was observed in the comparison between the two groups, there was no statistically significant difference (p>0.05). CONCLUSIONS: The addition of 2% ciprofloxacin does not alter the resistance to acid erosion of glass ionomer restoration, and may be considered a material that can to be used in the ART technique in subsequent studies. (AU)

Stenotrophomonas maltophilia keratitis treated with trimethoprim-sulfamethoxazole.

CASE REPORT: An 84 year-old woman with persistent epithelial defect and a dense stromal infiltrate post-corneal transplantation. According to the microbiological results, it was due to a Stenotrophomonas maltophilia (S. maltophilia) resistant to all antibiotics except trimethoprim-sulfamethoxazole (TMP/SMX). Healing was achieved after three weeks of treatment with oral and topical TMP/SMX. DISCUSSION: S. maltophilia is an opportunistic microorganism rarely described in ophthalmology. It is associated with conjunctivitis, keratitis, scleritis, dacryrocystitis, cellulitis, and endophthalmitis with significant morbidity. Treatment is complicated because of its resistances to broad-spectrum antibiotics. TMP/SMX monotherapy can be considered an option of treatment for this type of keratitis.

Comparison of two otologic suspensions of ciprofloxacin 2 mg/mL and hydrocortisone 10 mg/mL in the treatment of otitis externa: a multicenter, double-blind, randomized study / Comparação de duas suspensões otológicas de ciprofloxacino 2 mg/mL e hidrocortisona 10 mg/mL no tratamento da otite externa: um estudo multicêntrico, duplo-cego e randomizado

This was Phase III multicenter, double-blind, randomized, comparative safety and efficacy study in parallel groups of subjects, assessing non-inferiority between two commercially available otologic suspensions containing ciprofloxacin 2mg/mL and hydrocortisone 10mg/mL (Otociriax and Cipro HC®) in the treatment of acute diffuse otitis externa. Following screening and informed consent, subjects were randomly allocated into two treatment groups: Group A (treated with Otociriax) and Group B (treated with Cipro HC®). Treatment regimen in both groups was three drops, twice daily for seven days. The primary study endpoint was otitis cure, defined as elimination of pain, edema, and otorrhea. The secondary study endpoint was presence of side effects. Efficacy assessments included presence and intensity of otitis externa manifestations. Safety assessments included vital signs and physical examination, as well as adverse event monitoring. Study data analysis was performed using GraphPad Prism 5.0...

Efficacy and safety of fosfomycin-trometamol in the prophylaxis for transrectal prostate biopsy. Prospective randomized comparison with ciprofloxacin.

OBJECTIVE: Prostate biopsy is the standardized diagnostic method for prostate cancer. However, although there is not a standardized protocol, there are recommendations in order to reduce the incidence of complications. The objective of the present work is to assess the efficacy and safety of antibiotic prophylaxis in the prostate biopsy by comparing two antibiotic regimes: two doses of fosfomycin-trometamol 3g (FMT) every 48 hours with 10 doses of oral ciprofloxacin 500 mg every 12 hours during 5 days. MATERIAL AND METHODS: Randomized prospective study was performed with 671 patients who had undergone to walking transrectal ultrasound guided prostate biopsy. Patients of group A (n=312) were treated with ciprofloxacin, and patients of group B (n=359) with FMT. Efficacy and tolerability of two prophylactic regimes were compared. Urine culture was carried out at 2 weeks after biopsy. Initially, patients with asymptomatic bacteriuria were not treated with antibiotics; urine culture was repeated after 1 month, persistent bacteriuria was treated according to antibiogram. RESULTS: No differences between groups were found in age (P=.78), cancer presence (P=.9) or number of biopsy cylinders (P=.93). The mean number of cores obtained was 11.3 ± 3.25 (range 6-20). Digestive intolerance was observed for 9 patients (2.9%) of group A and 10 patients (2.8%) in group B. One patient (.3%) of group A showed severe allergic reaction. In total, 167 patients (24.6%) had complications: 16 (2.4%) fever, 47 (6.9%) hemospermia, 81 (11.9%) hematuria, 7 (1%) rectal bleeding and 16 (2.4%) urinary retention. No statistically differences between groups were observed (27.6% vs. 22.6%; P=.17). However, hemospermia was more frequent in group A (9.9% vs. 4.5%; P=.006). Bacteriuria after biopsy was detected in 44 patients (6.6%), being more frequent in group B patients (4.2% vs. 8.6%; P=.02) although a higher number of second treatment cycles were not needed (53.9% vs. 29%; P=.17). The likelihood of resistance to ciprofloxacin in patients with bacteriuria in A was greater than that of FMT in B (69.2% vs. 41.9%; P=.0004). CONCLUSIONS: Antibiotic prophylaxis with FMT (2 doses of 3g) in prostate biopsy is an alternative as effective and safe as ciprofloxacin (10 doses of 500 mg), which carries lower rate of resistance. According to our experience, this drug is a safe, well-tolerated, and easily manageable prophylactic option, facilitating patient compliance. More prospective multicenter studies are necessary to confirm these findings.

Estudio biofarmacéutico comparativo de marcas comerciales de tabletas de ciprofloxacino disponibles en el mercado colombiano / A comparative biopharmaceutical study of brands of ciprofloxacin tablets available on the Colombian market

Objetivo: Determinar la equivalencia biofarmacéutica de marcas comerciales de Ciprofloxacino 500 mg disponibles en el mercado colombiano. Métodos: Se tomaron 12 productos comerciales de Ciprofloxacino tabletas 500 mg, adquiridos en droguerías y farmacias de cuatro de las principales ciudades del país, a los cuales se les realizaron los siguientes ensayos: Identificación del principio activo por HPLC, contenido de ingrediente activo, uniformidad de dosificación, pruebas de desintegración y disolución; además se compararon los perfiles de disolución de los productos frente a uno tomado como referencia. Los resultados se analizaron a fin de establecer diferencias estadísticamente significativas y posible intercambiabilidad entre los productos evaluados. Resultados: El análisis comparativo de los productos, permitió evidenciar marcadas diferencias en cuanto a la liberaciónin vitrodel principio activo, con uno de los productos incumpliendo este importante parámetro de calidad. Todos los productos evaluados cumplen con las especificaciones oficiales de identificación y valoración del principio activo, uniformidad de dosificación y tiempo de desintegración. En cuanto a la cinética de disolución se encontraron diferencias entre las formulaciones, con productos de deficiente Eficiencia de Disolución (ED) y que a pesar de cumplir con la especificación a Q30, se disuelven muy lentamente. Conclusiones: Once productos cumplen con todas las especificaciones establecidas en la USP-33/NF28. Los resultados de este trabajo constituyen un valioso aporte para en un futuro cercano y en función de las políticas nacionales, poder establecer bioequivalencia entre estos productos.

Objective: Determining the biopharmaceutical equivalency of 500 mg ciprofloxacin tablets available on the Colombian market (i.e. comparing different trademarks). Methods: Twelve commercial 500 mg ciprofloxacin tablets were obtained from drugstores and pharmacies in Colombia’s four major cities. They were submitted to the following assays: HPLC identification of active ingredients, active ingredient content, dose uniformity, disintegration and dissolution tests and comparing the products’ dissolution profiles to that of the innovator. The results were analyzed to establish statistically significant differences and possible inter-changeability between the products being tested. Results: Comparative analysis of the products revealed marked differences regardingin vitrorelease of the active principle (one product failing this important quality parameter). All the products tested here complied with the official specifications for identifying and assaying the active principle, dosage unit uniformity and the disintegration test. Regarding dissolution kinetics, differences were found between formulations as some products had poor dissolution efficiency (DE) and dissolved very slowly despite complying with the Q30specification. Conclusions: 11 products complied with USP33-NF28specifications (guidelines on specifications for impurities in antibiotics). This work has made a valuable contribution towards establishing these products’ bioequivalence in the near future regarding national policy.

Síndrome de Stevens-Johnson: presentación de un caso / Stevens-Johnson syndrome: a case presentation

El Síndrome de Stevens-Johnson es una enfermedad inflamatoria aguda, caracterizada por un eritema multiforme vesiculobuloso de la piel y otros órganos, se califica como la etapa inicial de una reacción dérmica cuya presentación más severa es la necrólisis epidérmica tóxica. La causa de esta enfermedad está ligada al uso de algunos fármacos en un 60 %, además de causas infecciosas y algunos factores genéticos predisponentes. La ciprofloxacino produce el síndrome en una frecuencia menor de uno en diez mil. Caso Clínico: se presenta el caso de una paciente de 69 años de edad con diagnóstico de Amigdalitis, recibió tratamiento con ciprofloxacina tabletas, a las veinticuatro horas de evolución, desarrolló un síndrome de Stevens-Johnson en forma muy severa con manifestaciones cutáneas, oculares y de la mucosa oral, que evolucionó a una necrólisis epidérmica tóxica, se acompañó de otras complicaciones y tuvo un desenlace fatal. Discusión: el Síndrome de Stevens-Johnson y la necrólisis epidérmica tóxica pueden presentarse con una erupción morbiliforme que puede evolucionar a necrosis de piel, comprometer el tubo digestivo, la tráquea, los bronquios, el tracto urinario, la vagina y las conjuntivas. En los casos graves pueden aparecer complicaciones como lesiones oculares persistentes, neumonía, estenosis esofágica, insuficiencia renal aguda, insuficiencia hepática, trastornos hematológicos, pérdidas masivas de fluidos por vía transepidérmica y sepsis, esta última constituye la causa principal de muerte (AU)

Stevens-Johnson syndrome is an acute inflammatory disease, characterized by an erythema multiforme bullosum of the skin and other organs; it is considered the initial stage of a dermic reaction whose severest presentation is toxic epidermal necrolysis. Its cause is linked to the use of some drugs in a 60 %, as well as infectious causes and some genetic predisposing factors. Clinical case: a 69 years old woman with diagnosis of tonsillitis who received treatment with ciprofloxacin, to the twenty four hours of evolution the patient evolved a severe Stevens-Johnson syndrome with skin, ocular and oral mucosa manifestations that evolved to a toxic epidermal necrolysis, accompanied by other complications and had a fatal outcome. Discussion: Stevens-Johnson syndrome and toxic epidermal necrolysis may appeared with a morbilliform eruption that may develop to a necrosis of the skin, affecting digestive tube, trachea, the bronchi, urinary tract, vagina and conjunctivas. In the critical cases may appear complications like persistent ocular injuries, pneumonia, esophageal stenosis, chronic renal insufficiency, hepatic insufficiency, hematological disorders, massive losses of fluids by trans-epidermal via and sepsis, the last one constitute the main cause of death (AU)