Effect of Acetaminophen use during pregnancy on adverse pregnancy outcomes: a systematic review and meta-analysis.

INTRODUCTION: A high number of women are exposed to acetaminophen during pregnancy worldwide. This drug safety during pregnancy regarding preterm birth, birth weight, and fetal development has not been well described. This study investigated the effect of acetaminophen use during pregnancy on selected adverse pregnancy outcomes. AREAS COVERED: Databases were searched to identify studies reporting the effects of acetaminophen use during pregnancy on preterm birth, low birth weight, and small for gestational age. The studies' quality was assessed by the Newcastle-Ottawa Scale and the Methodological Index for Non-Randomized Studies. Risk ratios with 95% confidence intervals were estimated using a fixed or random-effects model. Six studies were included for final review, four cohort and two case-control studies. We found no increased risk of preterm birth (RR 0.97; 95% CI 0.59-1.58), and decreased risks of low birth weight (RR 0.65; 95% CI 0.59-0.72) and small for gestational age (RR 0.69; 95% CI 0.50-0.97). Acetaminophen exposure during the third trimester revealed non-significantly in the outcomes. EXPERT OPINION: Exposure to acetaminophen during pregnancy appears to not increase the risk of the outcomes analyzed. However, there is a lack of information regarding the exposure dose and frequency of acetaminophen use.

Resistance profiles to antimicrobial agents in bacteria isolated from acute endodontic infections: systematic review and meta-analysis.

Infected root canal or acute apical abscess exudates can harbour several species, including Fusobacterium, Porphyromonas, Prevotella, Parvimonas, Streptococcus, Treponema, Olsenella and not-yet cultivable species. A systematic review and meta-analysis was performed to assess resistance rates to antimicrobial agents in clinical studies that isolated bacteria from acute endodontic infections. Electronic databases and the grey literature were searched up to May 2015. Clinical studies in humans evaluating the antimicrobial resistance of primary acute endodontic infection isolates were included. PRISMA guidelines were followed. A random-effect meta-analysis was employed. The outcome was described as the pooled resistance rates for each antimicrobial agent. Heterogeneity and sensitivity analyses were performed. Subgroup analyses were conducted based upon report or not of the use of antibiotics prior to sampling as an exclusion factor (subgroups A and B, respectively). Data from seven studies were extracted. Resistance rates for 15 different antimicrobial agents were evaluated (range, 3.5-40.0%). Lower resistance rates were observed for amoxicillin/clavulanic acid and amoxicillin; higher resistance rates were detected for tetracycline. Resistance rates varied according to previous use of an antimicrobial agent as demonstrated by the subgroup analyses. Heterogeneity was observed for the resistance profiles of penicillin G in subgroup A and for amoxicillin, clindamycin, metronidazole and tetracycline in subgroup B. Sensitivity analyses demonstrated that resistance rates changed for metronidazole, clindamycin, tetracycline and amoxicillin. These findings suggest that clinical isolates had low resistance to ß-lactams. Further well-designed studies are needed to clarify whether the differences in susceptibility among the antimicrobial agents may influence clinical responses to treatment.

Therapeutic conducts and alternating antipyretics in the management of fever in children.

OBJECTIVES: To describe therapeutic conducts and the alternate use of antipyretics in children, and to evaluate factors associated with this use. METHODS: Cross-sectional study with 692 children from 0 to 6 years, living in southern Brazil. Through cluster sampling, we carried out household interviews with caregivers, using a structured questionnaire. A descriptive analysis was performed and the association between sociodemographic factors and the alternate use of antipyretics was evaluated. We analyzed 630 cases (91.0%), corresponding to children with history of fever. RESULTS: Around 73% of the caregivers answered that their first action with respect to a rising temperature was to medicate the child. The mean temperature considered fever by the caregivers was 37.4 °C and high fever, 38.7 °C. The use of alternate antipyretics was reported by 26.7% of respondents, justified by the lack of response to monotherapy and medical advice, in most cases. The most widely used drugs were dipyrone and paracetamol. Children whose main caregiver was a parent, with better economic conditions and higher educational level were more likely to use alternating therapy. Around 70% of the doses used were below the minimum recommended. CONCLUSIONS: The administration of medication to control fever is a common practice, including alternating antipyretics. Most caregivers consider fever some temperatures below those recommended, and pointed out non-response and medical advice as the main reasons for alternating antipyretics.