RESUMEN
BACKGROUND: Congenital toxoplasmosis is associated with severe complications. German state health insurance covers rubella, but not toxoplasmosis, immunity screening. We analysed the effect of socioeconomic factors on the efficiency of private toxoplasmosis screening during pregnancy. METHODS: Toxoplasmosis and rubella screening data (n = 5402 mothers) were collected within the population-based Survey of Neonates in Pomerania (SNiP). RESULTS: At the first-trimester screening, 34.4 % (88.1 %) of expecting mothers were immune to toxoplasmosis (rubella). Susceptibility for toxoplasmosis (rubella) was observed in 39.6 % (8.9 %) and 25.8 % (2.95 %) were not tested. Data on a 2(nd) screening were available in a subgroup of women with negative immunity showing less than 45 % participation rate. Active toxoplasmosis (no rubella) infection was observed in 0.3 % (n = 17) of pregnant women. A multiple logistic regression model (AIC = 719.67; AUC = 0.725) revealed that the likelihood of participating in a second toxoplasmosis screening increased among women with a good level of education and a steady partnership and decreased with paternal unemployment and the absence of breastfeeding. The highest probability of non-participation in toxoplasmosis screening was found among women with temporal burden and family responsibilities. A cost-benefit analysis showed that covering general screening for toxoplasmosis with health insurance saved costs. CONCLUSION: Toxoplasmosis carried a substantial risk of infection during pregnancy. Although increased socioeconomic status was positively associated with the participation in toxoplasmosis screening, this was not the case when pregnant women had strong temporal burden and family responsibilities. This data supports the need for toxoplasmosis screening among pregnant women as a general healthcare benefit covered by insurance.
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Tamizaje Masivo/economía , Aceptación de la Atención de Salud/estadística & datos numéricos , Complicaciones Parasitarias del Embarazo/diagnóstico , Diagnóstico Prenatal/economía , Factores Socioeconómicos , Toxoplasmosis/diagnóstico , Adulto , Femenino , Alemania , Humanos , Cobertura del Seguro/economía , Tamizaje Masivo/métodos , Tamizaje Masivo/psicología , Aceptación de la Atención de Salud/psicología , Embarazo , Complicaciones Parasitarias del Embarazo/economía , Complicaciones Parasitarias del Embarazo/psicología , Diagnóstico Prenatal/métodos , Diagnóstico Prenatal/psicología , Toxoplasma , Toxoplasmosis/economía , Toxoplasmosis/psicología , Adulto JovenRESUMEN
Vaccinations are the most successful and cost-effective measures for prevention of infections. Important pathogens of respiratory tract infections (e.g. influenza viruses and pneumococci) can be effectively treated by vaccinations. The seasonal trivalent and recently now quadrivalent influenza vaccines include antigens from influenza A and B type viruses, which have to be modified annually oriented to the circulating strains. The effective protection by influenza vaccination varies considerably (too short protection time, mismatch); therefore, administration late in the year is the best approach (November/December). Two pneumococcal vaccines are recommended for adults: the over 30-year-old 23-valent polysaccharide vaccine (PPV23) and the 4-year-old 13-valent conjugate vaccine (PCV13). The immunological and clinical efficacy of PPV23 is controversially discussed; however, a moderate reduction of invasive pneumococcal infections is widely accepted. The PCV13 stimulates a T-cell response and has currently demonstrated its clinical efficacy in an impressive study (CAPiTA). The problem of PCV13 is the relatively limited coverage of only 47% of the currently circulating invasive pneumococcal serotypes.
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Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Vacunas Neumococicas/administración & dosificación , Neumonía Neumocócica/prevención & control , Infecciones del Sistema Respiratorio/prevención & control , Esquema de Medicación , HumanosRESUMEN
We present the youngest pediatric patient so far with febrile ulcerative Mucha-Haberman disease (FUMHD) after an admitting clinical picture of hemorrhagic varicella infection. With a time to diagnosis of 25 days, the 20-month-old boy responded to low dose cyclosporine and prednisolone given for 3 months and is free of disease after 4 years of follow up. We describe a polyclonal CD8+ T cell response with elevated pro-inflammatory cytokines and a fivefold upregulation of the high-affinity Fc receptor type I (CD64) on granulocytes. Early consideration of FUMHD in the differential diagnosis of a systemic inflammatory disease combined with a generalized necrotizing rash is important for early and adequate management of children with this rare and challenging disease.
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Varicela/complicaciones , Herpes Simple/diagnóstico , Herpes Simple/patología , Pitiriasis Liquenoide/diagnóstico , Pitiriasis Liquenoide/patología , Antibacterianos/administración & dosificación , Antiinflamatorios/administración & dosificación , Linfocitos T CD8-positivos/inmunología , Ciclosporina/administración & dosificación , Granulocitos/química , Granulocitos/inmunología , Herpes Simple/tratamiento farmacológico , Humanos , Lactante , Masculino , Pitiriasis Liquenoide/tratamiento farmacológico , Prednisolona/administración & dosificación , Receptores de IgG/análisis , Resultado del TratamientoRESUMEN
INTRODUCTION AND OBJECTIVES: Determination of the efficacy of an early ultrasound examination followed by immediate treatment of hip joint dysplasia as well as measuring the therapeutic success in a population-based cohort study of neonates. MATERIAL AND METHODS: The Survey of Neonates in Pomerania (SNiP) study included 4,093 neonates which represents 95.1 % of the total neonatal population. Of these children 2,534 (61.9 %) underwent ultrasound examination of the hip joint during the U2 stage (3-10 days after birth). The mean gestational age was 38.9 weeks. The sonographic classification was performed according to Graf. RESULTS: Initially (U2 stage) 42 (1.66 %) children were reported to be in need of therapy (stage IIc or higher according to Graf). The analysis showed a significantly higher incidence in girls (32 girls vs. 10 boys, p < 0.023, χ(2) test) and in children who had a breech birth (116, 4.6 %). A genetic predisposition was ascertained in 180 (7.1 %) children. The children could be subdivided into two groups: 1) children who underwent hip joint ultrasound during both U2 and U3 and 2) children who were first screened at the U3 stage. Of the 49 out of 54 neonates where the ultrasound findings were positive at the U2 examination the hip joint was matured in 32 children at U3 (4-8 weeks), 11 children had to be treated for 8-12 weeks 5 children were treated for over 3 months and1 child needed surgical correction. CONCLUSION: The early diagnosis of hip maturation disorders and joint dysplasia facilitates early implementation of effective treatment. At our clinic over 60 % of the infants underwent the U2 check up and, given a pathological finding, could undergo early treatment. It was possible to successfully treat 78 % of these children with a Tübingen hip flexion splint in just 4-8 weeks. In contrast, infants who were first examined at the U3 stage needed treatment for 4-12 months. In our opinion, early diagnosis at the age of 3-10 days should be carried out for all newborns.
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Luxación de la Cadera/diagnóstico por imagen , Luxación de la Cadera/terapia , Férulas (Fijadores)/estadística & datos numéricos , Ultrasonografía/estadística & datos numéricos , Femenino , Alemania/epidemiología , Luxación de la Cadera/epidemiología , Humanos , Incidencia , Recién Nacido , Masculino , Factores de Riesgo , Resultado del TratamientoRESUMEN
Gram-negative pathogens are currently isolated frequently in invasive nosocomial infections and give rise to major therapeutic problems due to their resistance pattern. Metaanalyses of randomised controlled studies have demonstrated that an antibiotic combination treatment is not indicated in many cases. However, in critically ill patients (septic shock) and also in immunocompromised patients with previous intensive care as well as broad spectrum antibiotic treatment, a combination of antibiotics is recommended. This therapy should be based on the source of the infection, on local resistance data, on antibiotic pretreatment, on basic diseases of the patient and on current liver and renal functions. The start of therapy should be as fast as possible after collection of optimal materials for microbiological analysis. Dosage of selected antibiotics should be based on rational pharmacokinetic and pharmacodynamic parameters. A de-escalation of antibiotics is strongly recommended in all international guidelines based on the microbiological results and the clinical response of the patient. New antibiotics or therapeutic strategies against multiresistant Gram-negative pathogens will not be available in the next 5 to 10 years; therefore, it is absolute mandatory to use the currently still effective antibiotics, like carbapenems and polymyxins, very rationally and restrictively.
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Antibacterianos/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana Múltiple , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Antibacterianos/efectos adversos , Quimioterapia Combinada , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/microbiología , Humanos , Pruebas de Sensibilidad Microbiana , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/microbiología , Guías de Práctica Clínica como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Choque Séptico/tratamiento farmacológico , Choque Séptico/microbiologíaRESUMEN
Hereditary angioedema (HAE) is a rare type of angioedema caused by a quantitative or functional deficit of C1 inhibitor (C1 INH) that leads to excess production of bradykinin, which can result in acute localized swelling attacks in the skin or mucous membranes of the mouth, head and neck, extremities, gastrointestinal (GI) tract, genitals, trunk, and larynx. Angioedema in the respiratorytract maycause airway obstruction; severe abdominal pain, vomiting, or diarrhea may occur in the GI tract. Patients with HAE may be diagnosed and managed by HAE specialists or by primary care physicians depending on individual circumstances. Proper treatment requires differentiation from other forms of angioedema. Patients with HAE who are managed appropriately with medications that treat and prevent atttacks may have a lower risk of death from laryngeal edema and a better quality of life. Less frequent attacks may allow them to attend work, school, and leisure activities more regularlyand be free of the pain and disfigurement of HAE attacks moreoften.
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Algoritmos , Angioedema Hereditario Tipos I y II/diagnóstico , Angioedema Hereditario Tipos I y II/terapia , Antiinflamatorios no Esteroideos/uso terapéutico , Bradiquinina/análogos & derivados , Bradiquinina/uso terapéutico , Cromosomas Humanos Par 11/genética , Proteína Inhibidora del Complemento C1/genética , Proteína Inhibidora del Complemento C1/uso terapéutico , Análisis Mutacional de ADN , Angioedema Hereditario Tipos I y II/genética , Angioedema Hereditario Tipos I y II/prevención & control , Humanos , Péptidos/uso terapéutico , PlasmaAsunto(s)
Antibacterianos , Farmacorresistencia Bacteriana , Animales , Antibacterianos/administración & dosificación , Antibacterianos/historia , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/transmisión , Descubrimiento de Drogas/economía , Descubrimiento de Drogas/tendencias , Historia del Siglo XX , Historia del Siglo XXI , HumanosRESUMEN
BACKGROUND: A catheter lock solution containing 1.35% taurolidine and 4% citrate could potentially disrupt bacterial surface adherence and consecutive biofilm production due to the anti-adherence properties of taurolidine and the anticlotting and chelator activities of both compounds. AIM: To compare the impact on microbial catheter colonization and infectious complications of heparin and taurolidine citrate as central venous catheter (CVC) lock solutions in paediatric patients with haematological malignancies. METHODS: Seventy-one patients aged 1.4-18 years were randomized to two treatment groups using either heparin (N = 36) or taurolidine citrate (N = 35). Infectious complications and clinical side-effects were prospectively monitored and microbial colonization of catheters was assessed at the time of removal. FINDINGS: There were two bloodstream infections in the taurolidine citrate group versus nine in the heparin group (0.3 vs 1.3 infections per 1000 catheter-days; P = 0.03). Fever of unknown origin and catheter occlusions were observed with a similar frequency in both groups. Microbial colonization was found in 25.4% catheters. The time of no-lock use, but not the type of lock solution or time of observation, was a significant predictor of catheter colonization (P = 0.004). Colonization was not observed in CVCs used immediately with taurolidine citrate lock. Seven patients in the taurolidine citrate group (20%) experienced side-effects (nausea, vomiting, abnormal taste sensations). CONCLUSION: The use of taurolidine citrate lock solution was associated with a significant reduction in bloodstream infection in immunocompromised paediatric patients. Taurolidine citrate may prevent colonization of CVCs if used from the time of insertion, but not after a period of no-lock catheter use.
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Antiinfecciosos Locales/farmacología , Anticoagulantes/farmacología , Catéteres de Permanencia/microbiología , Heparina/farmacología , Taurina/análogos & derivados , Tiadiazinas/farmacología , Adolescente , Bacterias/aislamiento & purificación , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo/métodos , Niño , Preescolar , Femenino , Fiebre de Origen Desconocido/epidemiología , Fiebre de Origen Desconocido/prevención & control , Neoplasias Hematológicas/terapia , Humanos , Incidencia , Lactante , Masculino , Análisis de Supervivencia , Taurina/farmacologíaRESUMEN
Mortality of sepsis is still high. Crucial for therapeutic response are the early start of treatment as well as the choice of antibiotics or antibiotic combinations. ß-lactam antibiotics with bactericidal mode of action are often recommended in guidelines. But this antibiotic class can trigger the immune system to a maximum by releasing cell wall components or exotoxins. This may lead to a worsening of the patient's clinical situation. In contrast, antibiotics with bacteriostatic action often inhibit bacterial protein synthesis with decrease of production of virulence factors and minimize release of cell wall components. The purpose of this review is to summarise the significance of some bacteriostatic antibiotics and to discuss whether a combination of bactericidal and bacteriostatic agents may improve the course of the illness.
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Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Cuidados Críticos , Infección Hospitalaria/tratamiento farmacológico , Sepsis/tratamiento farmacológico , beta-Lactamas/uso terapéutico , Animales , Antibacterianos/efectos adversos , Bacterias/efectos de los fármacos , Bacterias/inmunología , Infecciones Bacterianas/inmunología , Pared Celular/efectos de los fármacos , Pared Celular/inmunología , Quimioterapia Combinada , Exotoxinas/sangre , Adhesión a Directriz , Humanos , Inmunización , Interleucina-8/sangre , Sepsis/inmunología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/inmunología , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/inmunología , Factores de Virulencia/antagonistas & inhibidores , beta-Lactamas/efectos adversosRESUMEN
OBJECTIVES: Aqueous Viscum album L. extracts are widely used for anti-cancer therapies. Due to their low solubility, triterpenes (which are known to act on cancers), do not occur in aqueous extracts in significant amounts. Using cyclodextrins, we have found it possible to solubilize mistletoe triterpene acids and to determine their effects on acute lymphoblastic leukaemia (ALL) in vitro and in vivo. MATERIALS AND METHODS: A C.B-17/SCID model of pre-B ALL (NALM-6) was used to test efficacy and mechanisms of treatment with lectin- and triterpene acid containing preparations in vivo. Cytotoxicity of increasing concentrations of V. album L. preparations was assessed in vitro. Apoptosis was determined using mitochondrial membrane potential measurements, annexin V/PI, western blot analyses and caspase inhibitor assays. RESULTS: Solubilized triterpene acid- or lectin-containing V. album L. extracts inhibited cell proliferation and demonstrated cytotoxic properties in vitro. Annexin V/PI and mitochondrial membrane potential assays indicated that dose-dependent induction of apoptosis was the main mechanism. Combination (viscumTT) of lectin- (viscum) and triterpene-containing (TT) extracts resulted in greatest induction of apoptosis. Furthermore, caspase activity demonstrated that these extracts were able to induce apoptosis through both caspase-8 and -9 dependent pathways. In vivo experimentation showed that treatment of mice with viscumTT combination prolonged mean survival to 50.5 days compared to 39.3 days in the phosphate-buffered saline group. CONCLUSION: Here for the first time, we have demonstrated that either solubilized triterpene acids or lectins and combinations thereof, induce dose-dependent apoptosis in the ALL cell line NALM-6 via caspase-8 and -9 dependent pathways.
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Antineoplásicos Fitogénicos/administración & dosificación , Fitoterapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Triterpenos/administración & dosificación , Viscum album/química , Animales , Antineoplásicos Fitogénicos/aislamiento & purificación , Apoptosis/efectos de los fármacos , Caspasa 3/metabolismo , Caspasa 8/metabolismo , Caspasa 9/metabolismo , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Citocromos c/metabolismo , Sinergismo Farmacológico , Femenino , Humanos , Potencial de la Membrana Mitocondrial/efectos de los fármacos , Ratones , Ratones SCID , Ácido Oleanólico/administración & dosificación , Extractos Vegetales/administración & dosificación , Extractos Vegetales/aislamiento & purificación , Lectinas de Plantas/administración & dosificación , Lectinas de Plantas/aislamiento & purificación , Leucemia-Linfoma Linfoblástico de Células Precursoras/metabolismo , Leucemia-Linfoma Linfoblástico de Células Precursoras/patología , Solubilidad , Triterpenos/aislamiento & purificación , Ensayos Antitumor por Modelo de XenoinjertoRESUMEN
OBJECTIVE: Acupuncture is successfully used to alleviate vomiting in children after general anesthesia. However there is no data on treatment of vomiting in children with gastroenteritis (GE) and pneumonia (PM). METHODS: Descriptive analysis of 18 cases, where acupuncture was used as an individual therapy attempt to treat vomiting in children with GE or PM before starting the conventional antiemetic therapy. Feasibility and acceptance by patients and parents as well as the incidence of vomiting and use of antiemetic drugs after acupuncture were recorded. RESULTS: Acupuncture was feasible in all children and application of the indwelling needles was tolerated without fear. Side effects were not observed. 13 patients stopped vomiting immediately after the insertion of acupuncture needles, none of the patients required conventional antiemetic medication. CONCLUSION: Acupuncture for the treatment of vomiting is feasible and acceptable. Suggested antiemetic effect should be examined in a randomized multicenter controlled trial.
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Acupuntura Auricular/instrumentación , Gastroenteritis/terapia , Neumonía/terapia , Vómitos/terapia , Puntos de Acupuntura , Enfermedad Aguda , Niño , Preescolar , Estudios de Factibilidad , Femenino , Humanos , Lactante , Tiempo de Internación , Masculino , Agujas , Aceptación de la Atención de Salud , Satisfacción del Paciente , Estudios RetrospectivosRESUMEN
Healthy adults aged ≥ 70 years (N=443) with no history of pneumococcal vaccination received 7- or 9-valent pneumococcal conjugate vaccine (PCV7 or PCV9) at 1 × (PCV7 only), 2 × (PCV7+PCV9), or 4 × (2 × PCV7+2 × PCV9) dosage in a randomised, open-label study evaluating pneumococcal protein conjugate vaccine (PnC). Controls received 23-valent pneumococcal polysaccharide vaccine (PPV). Both geometric mean concentration enzyme-linked immunosorbent assay and opsonophagocytic activity antibody titres assessed 1 month after vaccination were significantly increased over baseline titres for all PCV7 serotypes, with a trend toward a dose-dependent immune response. Local reactions for the 4 × dose, but not the 2 × dose, were statistically significantly higher than for the 1 × dose. No treatment-related serious adverse events occurred.
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Vacunas Neumococicas/administración & dosificación , Vacunas Neumococicas/inmunología , Vacunación/métodos , Anciano , Anciano de 80 o más Años , Anticuerpos Antibacterianos/sangre , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Proteínas Opsoninas/sangre , Fagocitosis , Vacunas Conjugadas/administración & dosificación , Vacunas Conjugadas/inmunologíaAsunto(s)
Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Neumonía/epidemiología , Neumonía/prevención & control , Antibacterianos/uso terapéutico , Infección Hospitalaria/microbiología , Farmacorresistencia Microbiana , Europa (Continente)/epidemiología , Humanos , Neumonía/microbiología , Neumonía Asociada al Ventilador/epidemiología , Neumonía Asociada al Ventilador/microbiología , Neumonía Asociada al Ventilador/prevención & control , Guías de Práctica Clínica como AsuntoRESUMEN
The European Union's attention to the problem of antibacterial resistance will soon reach a 10-year mark, but the rates of resistance in Gram-positive and Gram-negative bacteria are still increasing. This review focuses on the clinical impact of resistant Gram-positive bacteria on patients. Multiple drug resistance in pneumococcal infections will lead to more treatment failures and higher mortality, which so far have been seen with penicillins and pathogens with high-level resistance. Several studies have demonstrated higher mortality, prolonged length of hospital stay and higher costs associated with methicillin-resistant Staphylococcus aureus infections, in comparison with methicillin-susceptible Staphylococcus aureus infections. Similarly, vancomycin-resistant enterococci bloodstream infections have a negative impact with respect to mortality, length of hospital stay and costs, in comparison with infections due to vancomycin-susceptible enterococci. Several distinctive prophylactic and therapeutic approaches have to be undertaken to successfully prevent the clinical consequences of antibiotic resistance in Gram-positive bacteria. This review addresses the impact of antibiotic-resistant Gram-positive pathogens on clinical outcomes.
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Farmacorresistencia Bacteriana Múltiple , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/epidemiología , Costo de Enfermedad , Enterococcus/efectos de los fármacos , Enterococcus/aislamiento & purificación , Unión Europea , Infecciones por Bacterias Grampositivas/economía , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Tiempo de Internación , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/aislamiento & purificación , Resultado del Tratamiento , Resistencia a la VancomicinaAsunto(s)
Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas , Factores Inmunológicos/uso terapéutico , Neumonía Bacteriana , Terapia Combinada , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/mortalidad , Humanos , Neumonía Bacteriana/microbiología , Neumonía Bacteriana/mortalidad , Neumonía Bacteriana/terapia , Estudios Prospectivos , Respiración ArtificialRESUMEN
BACKGROUND: High functional antibody responses, establishment of immunologic memory, and unambiguous efficacy in infants suggest that an initial dose of conjugated pneumococcal polysaccharide (PnC) vaccine may be of value in a comprehensive adult immunization strategy. METHODS: We compared the immunogenicity and safety of 7-valent PnC vaccine (7vPnC) with that of 23-valent pneumococcal polysaccharide vaccine (PPV) in adults >/=70 years of age who had not been previously vaccinated with a pneumococcal vaccine. One year later, 7vPnC recipients received a booster dose of either 7vPnC (the 7vPnC/7vPnC group) or PPV (the 7vPnC/PPV group), and PPV recipients received a booster dose of 7vPnC (the PPV/7vPnC group). Immune responses were compared for each of the 7 serotypes common to both vaccines. RESULTS: Antipolysaccharide enzyme-linked immunosorbent assay antibody concentrations and opsonophagocytic assay titers to the initial dose of 7vPnC were significantly greater than those to the initial dose of PPV for 6 and 5 of 7 serotypes, respectively (P < .01 and P < .05, respectively). 7vPnC/7vPnC induced antibody responses that were similar to those after the first 7vPnC inoculation, and 7vPnC/PPV induced antibody responses that were similar to or greater than antibody responses after administration of PPV alone; PPV/7vPnC induced significantly lower antibacterial responses, compared with those induced by 7vPnC alone, for all serotypes (P < .05). CONCLUSION: In adults, an initial dose of 7vPnC is likely to elicit higher and potentially more effective levels of antipneumococcal antibodies than is PPV. In contrast with PPV, for which the induction of hyporesponsiveness was observed when used as a priming dose, 7vPnC elicits an immunological state that permits subsequent administration of 7vPnC or PPV to maintain functional antipolysaccharide antibody levels.
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Anticuerpos Antibacterianos/inmunología , Memoria Inmunológica , Vacunas Meningococicas/inmunología , Vacunas Neumococicas/inmunología , Anciano , Anticuerpos Antibacterianos/sangre , Ensayo de Inmunoadsorción Enzimática , Femenino , Vacuna Neumocócica Conjugada Heptavalente , Humanos , Inmunización Secundaria , Masculino , Vacunas Meningococicas/efectos adversos , Fagocitosis , Vacunas Neumococicas/efectos adversosAsunto(s)
Antibacterianos/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Farmacorresistencia Bacteriana , Antibacterianos/farmacología , Infección Hospitalaria/microbiología , Bacterias Gramnegativas/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/efectos de los fármacos , Resultado del TratamientoRESUMEN
Oral viridans streptococci are a reservoir of resistance genes for pathogens. Through prolonged exposure, long-acting macrolides (e.g., azithromycin) may induce the resistance of the commensals to macrolides more frequently than macrolides with a shorter half-life (e.g., clarithromycin). In a prospective, randomized, evaluator-blinded trial in healthy volunteers receiving standard courses of either azithromycin (n = 20) or clarithromycin (n = 20), we compared the susceptibility of oral viridans streptococci to macrolides over a period of 12 weeks. There was a significant temporal increase in the numbers of resistant isolates in both groups (p < 0.0005 at week 1). The proportion of macrolide-resistant isolates over time was significantly higher following azithromycin treatment (p = 0.0005), but returned to baseline values until week 12 in both groups. Temporal differential effects of azithromycin and clarithromycin on the induction of resistance were observed and need to be investigated regarding their effect on co-colonizing pathogens.
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Antibacterianos/efectos adversos , Antibacterianos/farmacología , Azitromicina/efectos adversos , Claritromicina/efectos adversos , Farmacorresistencia Bacteriana , Macrólidos/efectos adversos , Macrólidos/farmacología , Boca/microbiología , Estreptococos Viridans/efectos de los fármacos , Adulto , Antibacterianos/administración & dosificación , Azitromicina/administración & dosificación , Claritromicina/administración & dosificación , Femenino , Humanos , Macrólidos/administración & dosificación , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estreptococos Viridans/aislamiento & purificaciónRESUMEN
Pneumococcal infections (pneumonia, otitis media, sinusitis, meningitis) are common and usually involve toddlers and the elderly. Currently, two pneumococcal vaccines are in clinical use. The older vaccine consists of pure capsular polysaccharides from 23 pneumococcal serotypes and induces only a limited B-cell response because polysaccharides are poor antigens that stimulate mainly B-cells. In 2000, a vaccination program with a novel 7-valent pneumococcal conjugate vaccine was launched in the U.S. The conjugation of capsular polysaccharides with a highly immunogenic diphtheria toxoid protein induces both a T cell and B cell response that results in specific humoral and mucosal immunity. Since children are the main reservoir of pneumococci, the 7-valent conjugate vaccine seems to eradicate the respective pneumococcal serotypes within the population, as demonstrated by recent US data. Pronounced herd immunity resulted in a decrease in invasive pneumococcal diseases in vaccinees and non-vaccinees as well as in a reduction of antibiotic resistance rates. However, recent data suggest a replacement of vaccine-serotypes by non-vaccine serotypes, which conquer the ecological niche created by the vaccine. In order to encounter this problem a 13-valent conjugated vaccine is currently under development.
Asunto(s)
Farmacorresistencia Bacteriana/inmunología , Inmunidad Colectiva , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas , Humanos , Infecciones Neumocócicas/inmunología , Vacunas Neumococicas/inmunología , Vacunas Conjugadas/inmunologíaRESUMEN
BACKGROUND: Aspiration pneumonia (AP) and primary lung abscess (PLA), are diseases following aspiration of infectious material from the oropharynx or stomach. An antibiotic therapy, also covering anaerobic pathogens, is the treatment of choice. In this study we compared moxifloxacin (MXF) and ampicillin/sulbactam (AMP/SUL) concerning efficacy and safety in the treatment of AP and PLA. METHODS: Patients with pulmonary infections following aspiration were included in a prospective, open-label, randomized, multicenter trial. Sequential antibiotic therapy with MXF or AMP/SUL was administered until complete radiologic and clinical resolution. RESULTS: A total of 139 patients with AP and PLA were included, 96 were evaluable for efficacy (EE, 48 patients in each treatment group). The overall clinical response rates in both groups were numerically identical (66.7%). MXF and AMP/SUL were both well tolerated, even after long-term administration [median duration of treatment (range) in days MXF versus AMP/SUL: AP 11 (4-45) vs 9 (3-25), PLA 30.5 (7-158) vs 35 (6-90)]. CONCLUSION: In the treatment of aspiration-associated pulmonary infections moxifloxacin appears to be clinically as effective and as safe as ampicillin/sulbactam; but, however, having the additional benefit of a more convenient (400 mg qd) treatment.