Efficacy and safety of clarithromycin in pediatric patients with upper respiratory infections: a systematic review with meta-analysis.

PURPOSE: Upper respiratory infections (URIs) are one of the most common infectious diseases in children. Macrolides had been considered one of the best options of treatment. Instead of clarithromycin is one of the macrolides most used, meta-analysis about the safety and efficacy of this drug has not been published. MATERIALS AND METHODS: A systematic review with meta-analysis of randomized controlled trials (RCTs) was conducted. Studies in subjects < or = 12 years of age with URIs were included. Central Cochrane Registry, MEDLINE, EMBASE, Lilacs and Artemisa from 1966 to January of 2011 were reviewed. Clinical cure, clinical success, bacteriological eradication, relapse risk and adverse events risks were analyzed. Risks ratios (RR) with 95% confidence intervals (CI 95%) were calculated, using a fixed effects model. RESULTS: 24 studies, from a total of 76 RCTs were included. Clarithromycin was therapeutically equivalent to other antibiotics studied with respect to clinical cure [RR 1.02 (0.98 to 1.06), p NS], clinical success [RR 1.01 (0.99 to 1.03), p NS] and relapse risk [RR 1.34 (0.81 to 2.21), p NS], but was associated with a better bacteriological eradication [RR 1.06 (1.02 to 1.09), p 0.001], and a lower risk for related adverse events [RR 0.77 (0.65 to 0.90), p = 0.001]. CONCLUSIONS: High quality evidence showed that Clarithromycin is a safe and effective alternative for the treatment of URIs in pediatric patients. Is superior to other antibiotics in relation to bacterial eradication. Its equivalence profile related to clinical cure, clinical success and relapse risk, let to consider it as an important alternative.

[Bone mass accretion in healthy Mexican 6 to 12 year-olds measured by DEXA]. / Acumulación de masa ósea medida por DEXA periférica en niños mexicanos sanos de entre 6 a 12 años de edad.

OBJECTIVE: To describe bone mass density in a group of healthy 6 to 12 year-old Mexican children by a peripheral DEXA, adjusted for gender. MATERIAL AND METHODS: A cross-sectional study between 2006 and 2007 conducted in 1 965 children (982 male), without any medical condition, randomized from elementary schools in Mexico City. RESULTS: Changes in bone mineral density in girls show two phases: a lineal accretion (6-9 years) and an exponential curve (10 years and older); in boys these growth rates are less pronounced. CONCLUSIONS: It is considered that optimal interventions to improve bone mass density and peak bone mass should be performed between 6 to 12 years of age.

Acumulación de masa ósea medida por DEXA periférica en niños mexicanos sanos de entre 6 a 12 años de edad / Bone mass accretion in healthy Mexican 6 to 12 year-olds measured by DEXA

OBJETIVO:Conocer la densidad mineral ósea (DMO), evaluada a través de DEXA periférica, ajustada por sexo, en una muestra de escolares mexicanos sanos de entre 6 a 12 años de edad. MATERIAL Y MÉTODOS: Estudio transversal efectuado en 1 965 escolares (982 masculinos), seleccionados de forma aleatoria en la Ciudad de México en 2006 y 2007. Se aplicó estadística descriptiva para variables nominales o categóricas y numéricas. RESULTADOS:La curva de cambio de la DMO en niñas muestra dos etapas: un crecimiento lineal (entre los 6 a 9 años de edad) y uno exponencial (a partir de los 10 años), mientras que en los niños las tasas de crecimiento son menos pronunciadas. CONCLUSIONES:Las intervenciones para mejorar la DMO y el pico máximo de masa ósea deben realizarse entre los 6 a los 12 años de edad.

OBJECTIVE:To describe bone mass density in a group of healthy 6 to 12 year-old Mexican children by a peripheral DEXA, adjusted for gender. MATERIAL AND METHODS: A cross-sectional study between 2006 and 2007 conducted in 1 965 children (982 male), without any medical condition, randomized from elementary schools in Mexico City. RESULTS:Changes in bone mineral density in girls show two phases: a lineal accretion (6-9 years) and an exponential curve (10 years and older); in boys these growth rates are less pronounced. CONCLUSIONS:It is considered that optimal interventions to improve bone mass density and peak bone mass should be performed between 6 to 12 years of age.

Immune response to nucleotide-supplemented infant formulae: systematic review and meta-analysis.

Human milk is recommended as the only alimentary source for the first six months of life. Additionally there is a medical and social need for safe and effective alternative forms of nutrition for infants who cannot be fed with breast milk. Recently the safety and efficacy of some ingredients in infant formulae, such as nucleotides have been discussed. This systematic review analyzed the available evidence to establish the efficacy, safety and dose-response effect of ribonucleotide-supplemented infant formulae (RSIFs). Randomised controlled clinical trials (RCTs) comparing RSIFs to formulae without nucleotides or breast milk were considered in this review. Outcome measures were: antibody titres to common paediatric vaccinations, total lymphocytes, lymphocyte subclasses and NK-cells, episodes of diarrhoea and acute respiratory infection. Publication quality was determined using Jadad and CONSORT guidelines. Results were combined using a random effects model and reported through standardised mean differences (WMD) or risk ratio (RR). Systematic review and meta-analysis showed that RSIFs were associated with a better antibody response to immunisation with Haemopillus influenzae vaccine [SMD 1.74 (99%CI 1.43-2.05), P=0.001], diphtheria toxoid [SMD 0.94 (0.75-1.12), P=0.001], oral polio vaccine [SMD 0.73 (0.51-0.95), P=0.001], and fewer episodes of diarrhoea [RR 0.67 (0.58-0.76), P=0.02]. We did not find a major risk of upper respiratory infections [RR 1.11 (0.90-1.36), P=0.50]. Available evidence suggests a positive benefit of RSFIs on infant health without any risk. These benefits begin with nucleotide addition of 1.9 mg/418.4 kJ and are maintained or increased with 10.78 mg/418.4 kJ.