RESUMO
La aparición de úlceras perianales en relación con una pomada antihemorroidal es una condición nunca antes reportada en la literatura. Presentamos una serie de 11 casos de 10 hospitales españoles con diagnóstico de úlceras perianales tras la aplicación de una misma pomada antihemorroidal con acetónido de triamcinolona, lidocaína y pentosano polisulfato sódico como principios activos. No se ha podido identificar ninguna condición previa o enfermedad concomitante que pudiera justificar un diagnóstico etiológico alternativo y tras retirar la pomada antihemorroidal se ha evidenciado una resolución completa de las úlceras en un periodo medio de 8 semanas. Esta serie de casos evidencia el potencial efecto dañino de un producto farmacéutico no sujeto a prescripción ni seguimiento médico y la necesidad de interrogar por el uso de agentes tópicos ante la aparición de úlceras perianales (AU)
The development of perianal ulcers related to the use of a hemorrhoidal ointment has not been reported in the literature. We describe a series of 11 patients who were treated for perianal ulcers in 10 Spanish hospitals after they used the same ointment containing the active ingredients triamcinolone acetonide, lidocaine, and pentosan polysulfate sodium. No prior or concomitant conditions suggesting an alternative cause for the condition could be identified, and after the patients stopped using the ointment, their ulcers cleared completely in 8 weeks on average. This case series shows the damage that can be caused by an over-the-counter pharmaceutical product used without medical follow-up. It also illustrates the need to ask patients with perianal ulcers about any topical agents used before the lesions appeared (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fissura Anal/induzido quimicamente , Hemorroidas/tratamento farmacológico , Pomadas/efeitos adversos , Triancinolona Acetonida/efeitos adversos , Lidocaína/efeitos adversos , Poliéster Sulfúrico de Pentosana/efeitos adversosRESUMO
The development of perianal ulcers related to the use of a hemorrhoidal ointment has not been reported in the literature. We describe a series of 11 patients who were treated for perianal ulcers in 10 Spanish hospitals after they used the same ointment containing the active ingredients triamcinolone acetonide, lidocaine, and pentosan polysulfate sodium. No prior or concomitant conditions suggesting an alternative cause for the condition could be identified, and after the patients stopped using the ointment, their ulcers cleared completely in 8 weeks on average. This case series shows the damage that can be caused by an over-the-counter pharmaceutical product used without medical follow-up. It also illustrates the need to ask patients with perianal ulcers about any topical agents used before the lesions appeared.
RESUMO
OBJECTIVE: Gram-positive bacteria are the leading cause of prosthetic joint infection (PJI). Dalbavancin is a lipoglycopeptide with remarkable pharmacokinetic properties and high bactericidal activity against most Gram-positive bacteria. Although clear evidence regarding its effectiveness in bone and joint infections lacks, recent studies suggest a promising role of dalbavancin in PJI. METHODS: From June 1st 2016 to May 1st 2018, all patients diagnosed of PJI and treated with DAL alone or in combination with other drugs were retrospectively evaluated. Dalbavancin susceptibility of every isolate was studied following CLSI criteria. The primary objective was to assess the clinical efficacy and tolerability of the drug in patients with PJI. A cost-analysis was performed following the DALBUSE study methodology. RESULTS: Sixteen patients were treated with dalbavancin, eight with total hip arthroplasty infection (THAi) and eight with total knee arthroplasty infection (TKAi). Staphylococcus spp. and Enterococcus spp. were the microorganisms involved. No major side effects were detected. Infection resolved in 12 patients. In 2 patients the treatment failed, and another patient died due to unrelated causes. One patient is currently being treated for hematogenous-spread knee infection secondary to prosthetic aortic arch endocarditis. After discontinuation of dalbavancin, and excluding patients who died or with clinical failure, the median follow up of the cohort was 503 days (interquartile range IQR, 434.5 to 567 days). We calculate that US$ 264,769 were saved. CONCLUSIONS: This study suggests that dalbavancin treatment for PJI caused by Gram-positive bacteria is a safe and effective option that reduces hospital stay and costs. Future reports are needed to confirm these findings.
