World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): probiotics

BACKGROUND: Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20-30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention. OBJECTIVE: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy. METHODS: We identified the most relevant clinical questions and performed a systematic review of randomized controlled trials of probiotics for the prevention of allergy. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. We searched for and reviewed the evidence about health effects, patient values and preferences, and resource use (up to November 2014). We followed the GRADE evidence-to-decision framework to develop recommendations. RESULTS: Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing allergy in children. However, considering all critical outcomes in this context, the WAO guideline panel determined that there is a likely net benefit from using probiotics resulting primarily from prevention of eczema. The WAO guideline panel suggests: a) using probiotics in pregnant women at high risk for having an allergic child; b) using probiotics in women who breastfeed infants at high risk of developing allergy; and c) using probiotics in infants at high risk of developing allergy. All recommendations are conditional and supported by very low quality evidence. CONCLUSIONS: WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding, and whether to give them to infants.

Estudio de la diversidad en el tratamiento de la neumonía adquirida en la comunidad / Study of the diversity in treatment of community-acquired pneumonia

Existen numerosos protocolos o recomendaciones basadas en criterios clínico-radiológicos aplicables al tratamiento antibiótico de la neumonía adquirida en la comunidad. Este trabajo evalúa la diversidad observada en el tratamiento de dicha infección en los Servicios de Medicina Interna y Neumología de nuestro hospital. Se siguieron 71 pacientes ingresados en ambos servicios desde el Servicio de Urgencias, con neumonía adquirida en la comunidad, recogiendo variables clínicas (al ingreso y evolución), microbiológicas y terapéuticas. En los resultados se observa una marcada diferencia en las pautas terapéuticas empleadas entre ambos servicios, con diferencias en los antibióticos elegidos, su duración y vía de administración, que no se explican suficientemente por las diferencias en el perfil clínico de los pacientes. Sólo los pacientes con enfermedad pulmonar crónica parecen asociarse a una mayor homogeneidad en las pautas aplicadas (menor diversidad). En cuanto al cumplimiento de las recomendaciones de sociedades científicas, hemos encontrado hasta un 7 por ciento de pautas no recomendadas, con una media de 2,5 cambios (en pauta, dosis o vía de administración) por paciente, junto con una prolongada utilización de la vía intravenosa (7,4 días) en la terapia secuencial. (AU)

[Study of the diversity in treatment of community-acquired pneumonia]. / Estudio de la diversidad en el tratamiento de la neumonía adquirida en la comunidad.

There are a great number of protocols or recommendations focused on clinical-radiological criteria for the antibiotic treatment of community-acquired pneumonia (CAP). This report assesses the diversity found in the treatment of CAP in the Internal Medicine and Pneumology Services of our hospital. Seventy-one patients referred from the Emergency Department were treated in both services, and clinical, microbiological and therapeutic variables were collected. It was shown that there are significant differences between the therapeutic guidelines used in each service (antibiotics chosen, their length and form of administration) which could not be explained by the patients' clinical profile. Greater homogeneity in the guidelines was found only for patients with chronic obstructive pulmonary disease. In relation to the adherence to recommendations of scientific societies, we found that 7% of the guidelines were not recommended; there was an average of 2.5 changes (in the antibiotic, dose or administration form) per patient; and a larger period of intravenous administration (7.38 days) than recommended for sequential therapy