RESUMEN
ABSTRACT: We conducted a systematic literature review and meta-analysis to assess the efficacy of alternative treatments for neurosyphilis. We searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane, Scopus, and Web of Science from database inception to September 2023, for studies in neurosyphilis that compared penicillin monotherapy with other treatments. We focused on the impact of these therapies on treatment response, but also assessed data regarding reinfection and adverse drug events. Random-effect models were used to obtain pooled mean differences. Of 3415 screened studies, 6 met the inclusion criteria for the systematic literature review. Three studies provided quantitative data that allowed for inclusion in the meta-analysis. Our analysis revealed that the efficacy of intravenous (IV) ceftriaxone 2 g daily for 10 days (51 patients) did not appear statistically different compared with IV penicillin G 18 to 24 million units daily for 10 days (185 patients) for neurosyphilis (pooled odds ratio, 2.85; 95% confidence interval, 0.41-19.56; I 2 = 49%). No statistical difference between ceftriaxone and penicillin was identified in people living with human immunodeficiency virus (HIV) (pooled odds ratio, 4.51; 95% confidence interval, 0.50-40.49; I 2 = 34%). We concluded that alternative therapy with IV ceftriaxone appears similar to penicillin, potentially expanding treatment options for neurosyphilis. Other treatment options including doxycycline warrant further study.
Asunto(s)
Antibacterianos , Neurosífilis , Humanos , Masculino , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Ceftriaxona/administración & dosificación , Ceftriaxona/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/complicaciones , Neurosífilis/complicaciones , Neurosífilis/tratamiento farmacológico , Penicilina G/administración & dosificación , Penicilina G/efectos adversos , Penicilinas/administración & dosificación , Penicilinas/efectos adversos , Resultado del TratamientoRESUMEN
Brucella melitensis is the main cause of human brucellosis worldwide and is considered the most virulent and neurotropic species. In Mexico, this species is considered endemic, being reported since the first decade of the 20th century. Here we present a case of subacute transverse myelitis with the isolation and identification of B. melitensis as the causative agent of Neurobrucellosis in a female patient from the coastal state of Guerrero, Mexico.
Asunto(s)
Brucella melitensis/aislamiento & purificación , Brucelosis/diagnóstico , Mielitis Transversa/diagnóstico , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Brucelosis/complicaciones , Brucelosis/tratamiento farmacológico , Ceftriaxona/administración & dosificación , Ceftriaxona/uso terapéutico , Diagnóstico Diferencial , Femenino , Humanos , Infusiones Intravenosas , Mielitis Transversa/complicaciones , Mielitis Transversa/tratamiento farmacológicoRESUMEN
Introduction: Usage of ceftriaxone-based therapy to treat Methicillin-Susceptible Staphylococcus aureus (MSSA) infections is a controversial issue, from in vitro to clinical studies.Area covered: We conducted a literature review using PubMed of articles with ceftriaxone pharmacokinetics parameters and built a probability of target attainment (PTA) based on PK values from stable conditions (non-critically-ill patients) with goals of fT>55%, fT>75%, and fT>100%. Ceftriaxone's minimal inhibitory concentration from 31 MSSA strains (0.25-64 mg/L) was used to build the cumulative fraction response (CFR). The isolates were clinically relevant from blood, bronchoalveolar lavage, and soft tissue biopsy.Expert opinion: The results from controversies about using ceftriaxone for MSSA infections have been commonly addressed in the literature. However, variables such as (i) pharmacokinetic profile, (ii) pharmacodynamic target, (iii) site of infection, and (iv) MIC distributions may influence divergences. From this pharmacokinetics-pharmacodynamics perspective, ceftriaxone may be a reasonable option for MSSA infections when the MIC50 and MIC90 were 4 mg/L and 8 mg/L. CFR analysis demonstrated that ceftriaxone 1 g q24 h could be used if bacteriostasis is the aim (fT>55%), while 1 g q12h should be used for bactericidal effects (fT>75% or fT>100%). These dosing regimens should be considered in other clinical trials.
Asunto(s)
Antibacterianos/administración & dosificación , Ceftriaxona/administración & dosificación , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/efectos de los fármacos , Antibacterianos/farmacocinética , Antibacterianos/farmacología , Ceftriaxona/farmacocinética , Ceftriaxona/farmacología , Esquema de Medicación , Farmacorresistencia Bacteriana , Humanos , Meticilina/farmacología , Pruebas de Sensibilidad Microbiana , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
HACEK organisms (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella species) are rare causes of endocarditis. HACEK organisms are fastidious and may escape detection by culture techniques, but the use of molecular studies may aid diagnosis. A 10-year review of pediatric HACEK endocarditis cases at Texas Children's Hospital identified 10 patients, with 2 cases recognized by next-generation sequencing, highlighting potential benefits of these assays.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Secuenciación de Nucleótidos de Alto Rendimiento , Adolescente , Antibacterianos/administración & dosificación , Ceftriaxona/administración & dosificación , Niño , Endocarditis Bacteriana/tratamiento farmacológico , Cardiopatías Congénitas/complicaciones , Humanos , Lactante , Kingella/aislamiento & purificación , Masculino , Estudios Retrospectivos , Centros de Atención TerciariaRESUMEN
The metabolic peculiarities of felines favor an intoxication. Fifty healthy female cats were divided into five groups: PG (placebo group), G2 (cefazolin), G3 (ceftriaxone), G4 (enrofloxacin) and G5 (ampicillin) were used. The parameters evaluated were: total expired carbon dioxide (ETCO2), oxygen saturation in hemoglobin (SpO2), heart rate (HR), respiratory rate (RR), body temperature (BT), systolic, mean and diastolic blood pressure (SBP, mBP and DBP) by invasive method, at T0, 5 (T5), 10 (T10), 15 (T15), 20 (T20), 25 (T25) and 30 (T30) minutes after administration of the treatments. HR presented reduction in G2 compared to PG at all times, except T20, and in G4, T25 and T30 were lower than the T0 values (P<0.05). BT showed increase in the G3 at T0 and T5 and all groups showed reduction in the values of BT relative to T0 (P<0.05). ETCO2 increased in G2 and G5 at all times compared to PG (P<0.05) and there were no differences among the times within each group. It was concluded that ceftriaxone is safer for the prophylactic antimicrobial use in cats, however the other antimicrobials are also indicated, because all the parameters, in all groups, basically did not change over the study and when this occurs it remains in reference interval.(AU)
As peculiaridades metabólicas dos felinos favorecem quadro de intoxicação. Foram utilizadas 50 gatas saudáveis, que foram divididas em cinco grupos: GP (grupo placebo), G2 (grupo cefazolina), G3 (grupo ceftriaxona), G4 (grupo enrofloxacina) e G5 (grupo ampicilina). Os seguintes parâmetros foram avaliados: dióxido de carbono expirado (ETCO2), saturação de oxigênio na hemoglobina (SpO2), frequência cardíaca (FC), frequência respiratória (FR), temperatura corporal (T°C), pressão arterial sistólica,média e diastólica (PAS, PAM e PAD), pelo método invasivo, em 0 (T0), 5 (T5), 10 (T10), 15 (T15), 20 (T20), 25 (T25) e 30 (T30) minutos após a administração dos tratamentos. A FC apresentou redução no G2 em relação ao GP em todos os momentos, exceto no T20, e, no G4, o T25 e o T30 foram inferiores aos valores do T0 (P<0,05). A T°C apresentou aumento no G3 no T0 e no T5, e todos os grupos apresentaram redução nos valores da T°C em relação ao T0 (P<0,05). O ETCO2 apresentou aumento no G2 e no G5, em todos os momentos, em relação ao GP (P<0,05). Concluiu-se que a ceftriaxona é mais segura para uso profilático em gatos, entretanto os outros antibióticos também são recomendados, pois todos os parâmetros praticamente não se modificaram e, quando alterados, mantiveram-se dentro dos padrões de referência.(AU)
Asunto(s)
Animales , Gatos , Ceftriaxona/administración & dosificación , Frecuencia Respiratoria/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Antiinfecciosos/administración & dosificación , Antiinfecciosos/efectos adversos , Hemodinámica , Anestesia Intravenosa/veterinariaRESUMEN
BACKGROUND: The parasite Entamoeba histolytica is the causal agent of amoebiasis, a worldwide emerging disease. Amebic brain abscess is a form of invasive amebiasis that is both rare and frequently lethal. This condition always begins with the infection of the colon by E. histolytica trophozoites, which subsequently travel through the bloodstream to extraintestinal tissues. CASE PRESENTATION: We report a case of a 71-year-old female who reported an altered state of consciousness, disorientation, sleepiness and memory loss. She had no history of hepatic or intestinal amoebiasis. A preliminary diagnosis of colloidal vesicular phase neurocysticercosis was made based on nuclear magnetic resonance imaging (NMRI). A postsurgery immunofluorescence study was positive for the 140 kDa fibronectin receptor of E. histolytica, although a serum analysis by ELISA was negative for IgG antibodies against this parasite. A specific E. histolytica 128 bp rRNA gene was identified by PCR in biopsy tissue. The final diagnosis was cerebral amoebiasis. The patient underwent neurosurgery to eliminate amoebic abscesses and was then given a regimen of metronidazole, ceftriaxone and dexamethasone for 4 weeks after the neurosurgery. However, a rapid decline in her condition led to death. CONCLUSIONS: The present case of an individual with a rare form of cerebral amoebiasis highlights the importance of performing immunofluorescence, NMRI and PCR if a patient has brain abscess and a poorly defined diagnosis. Moreover, the administration of corticosteroids to such patients can often lead to a rapid decline in their condition.
Asunto(s)
Absceso Encefálico/diagnóstico , Absceso Encefálico/parasitología , Infecciones Parasitarias del Sistema Nervioso Central/diagnóstico , Entamebiasis/diagnóstico , Anciano , Animales , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/cirugía , Ceftriaxona/administración & dosificación , Infecciones Parasitarias del Sistema Nervioso Central/tratamiento farmacológico , Infecciones Parasitarias del Sistema Nervioso Central/patología , Infecciones Parasitarias del Sistema Nervioso Central/cirugía , Terapia Combinada , ADN Protozoario/análisis , Dexametasona/administración & dosificación , Quimioterapia Combinada , Entamoeba histolytica/genética , Entamoeba histolytica/inmunología , Entamoeba histolytica/aislamiento & purificación , Entamebiasis/tratamiento farmacológico , Entamebiasis/patología , Entamebiasis/cirugía , Resultado Fatal , Femenino , Humanos , Metronidazol/administración & dosificación , Procedimientos Neuroquirúrgicos , Pruebas SerológicasRESUMEN
INTRODUCTION: Ceftriaxone is a wide-spectrum antibiotic frequently used in pediatrics. Biliary pseudolithiasis is a well-known side-effect occurring in 15-57% of cases. However, nephrolithiasis is extremely infrequent, with very few related publications. CASE REPORT: We present the case of a 9-year-old patient with ceftriaxone-treated complicated acute appendicitis who developed biliary pseudolithiasis and nephrolithiasis. During hospitalization, the patient presented with pseudolithiasis complications such as mild pancreatitis and bilateral ureterohydronephrosis with acute renal failure. REMARKS: Suspecting ceftriaxone-associated biliary pseudolithiasis and/or nephrolithiasis is key to achieve an early diagnosis and prevent complications such as those reported in this patient. Early discontinuation is essential as an initial treatment measure.
INTRODUCCION: La ceftriaxona es un antibiótico de amplio espectro frecuentemente utilizado en pediatría. La pseudolitiasis vesicular es un efecto adverso bien conocido, que se presenta en un 15 a 57% de los casos. En cambio la litiasis renal es extremadamente infrecuente con muy pocas publicaciones al respecto. CASO CLINICO: Se presenta el caso de un paciente de 9 años que, durante tratamiento con ceftriaxona por una apendicitis aguda complicada, desarrolla pseudolitiasis vesicular y urinaria. Durante la misma internación el paciente presenta una pancreatitis leve y una ureterohidronefrosis bilateral, con insuficiencia renal aguda, como complicaciones de las pseudolitiasis. COMENTARIOS: La sospecha de la formación de litiasis renal y/o vesicular asociada al uso de ceftriaxona es fundamental para un diagnóstico temprano y prevención de complicaciones como las reportadas en este paciente, siendo fundamental la suspensión precoz del fármaco como inicio del tratamiento.
Asunto(s)
Antibacterianos/efectos adversos , Ceftriaxona/efectos adversos , Cálculos Renales/inducido químicamente , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Antibacterianos/administración & dosificación , Apendicitis/tratamiento farmacológico , Ceftriaxona/administración & dosificación , Niño , Humanos , Cálculos Renales/diagnóstico , Masculino , Pancreatitis/diagnóstico , Pancreatitis/etiologíaRESUMEN
ß-Lactam antibiotics such as ceftriaxone, are potent stimulators of the expression of l-glutamate transporter GLT-1 and may exert neuroprotective effects when chronically used in rats and mice. In this study, we used two animal models to test the neurological effect of subchronic treatment with ceftriaxone: experimental acute glaucoma in Wistar rats and induction of acute seizures with pentylenetetrazole in mice. We also assessed the performance of mice in the rotarod to calculate therapeutic indexes and exploratory activity in the open field. Our results showed that subchronic use of ceftriaxone was neuroprotective in both models, reducing injury in acute ischemia and ischemia/reperfusion in specific layers of retina and leading to a decrease in the seizure severity score. In behavioral experiments, we observed that ceftriaxone increased hyperactivity followed by a decrease in exploratory behavior in the open field, and there was no motor impairment in the rotarod test. We conclude that ceftriaxone may be useful as a tool in the development of new neuroprotective drugs targeting diseases which present a possible dysfunction in the balance of glutamatergic neurotransmission.
Asunto(s)
Antibacterianos/administración & dosificación , Ceftriaxona/administración & dosificación , Convulsivantes/farmacología , Glaucoma/fisiopatología , Fármacos Neuroprotectores/administración & dosificación , Convulsiones/prevención & control , Tetrazoles/farmacología , Enfermedad Aguda , Animales , Conducta Animal/efectos de los fármacos , Masculino , Ratones , Ratas , Ratas WistarRESUMEN
Ceftriaxone (CFX) is a ß-lactam antibiotic with analgesic properties. However, its role in the formalin-induced nociception remains unknown. The purpose of this study was to investigate the antinociceptive effect of CFX in the 1% formalin test in rats. Formalin induced a typical nociceptive response (flinching behavior) of two phases. Local peripheral pretreatment (20 min) with CFX (400-800 µg/paw) slightly attenuated the flinching behavior in phase 2, but not phase 1. Acute intraperitoneal pretreatment (20 min) also reduced phase 2 of the formalin test. In both cases, CFX induced a dose-dependent antinociception. We also tested the effect of CFX 1 day after its administration and in two schedules of repeated administration. One-day pretreatment with CFX (50-400 mg/kg, ip) induced a dose-dependent antinociceptive effect in formalin-treated rats. Repeated administration (daily during 3 or 7 days) with CFX (50-400 mg/kg, ip) diminished formalin-induced nociception. Results suggest that local or systemic as well as single or repeated administration of CFX reduces formalin-induced nociception.
Asunto(s)
Analgésicos/administración & dosificación , Antibacterianos/administración & dosificación , Ceftriaxona/administración & dosificación , Nocicepción/efectos de los fármacos , Dolor/tratamiento farmacológico , Animales , Esquema de Medicación , Femenino , Formaldehído , Inyecciones Intraperitoneales , Dolor/inducido químicamente , Ratas WistarRESUMEN
Medical management of abdominal abscesses in horses requires prolonged antibiotic therapy and presents varied success rates. A 6-year-old male horse with a history of colic and multiple abdominal punctures to relieve gas was attended. At admission, tachycardia, tachypnea, hyperthermia, mucosal congestion, dehydration, and rigid gait were observed. The association of physical examination, laboratory and ultrasonographic findings allowed the diagnoses of peritonitis and abdominal abscess. Supporting treatment plus broad spectrum antibiotic therapy was performed: daily intraperitoneal ceftriaxone (25 mg/kg, 7 days); daily intravenous gentamicin (6.6 mg/kg, 7 days); per os metronidazole three times a day (15 mg/kg 12 days), followed by the same dose twice a day (15 mg/kg 33 days), totaling 45 days of treatment. Plasma fibrinogen and ultrasonographic examination were the most effective tools to evaluate abscess evolution. There was normalization of the physical examination 24 h after beginning the treatment, consecutive regression of the nucleated cell count in the peritoneal fluid, and regression of plasma fibrinogen and size of the abscess. On the 10th treatment day, the animal was discharged from the hospital, maintaining oral therapy with metronidazole every 12 h (15 mg / kg). When the animal returned on the 30th day, an abscess size regression was observed. However, there was no resolution, and therapy with metronidazole was maintained. On the 45th day of treatment, a new hospital evaluation was performed, where the abscess resolved, and metronidazole was suspended. It is highlighted that the therapeutic association used in the treatment of abdominal infection and abscess resulted in a rapid clinical response.(AU)
O tratamento conservativo dos abscessos abdominais em equinos requer antibioticoterapia prolongada e apresenta variadas taxas de sucesso. Foi atendido um cavalo de seis anos de idade, com histórico de cólica e múltiplas punções abdominais por agulha para esvaziamento de gás. Na admissão, foram observados taquicardia, taquipnéia, hipertermia, congestão mucosa, desidratação e marcha rígida. A associação do exame físico, achados laboratoriais e ultrassonográficos permitiu o diagnóstico de peritonite e abscesso abdominal. Foi realizado tratamento suporte e antibioticoterapia de amplo espectro: ceftriaxona intraperitoneal diária (25 mg/kg, 7 dias); gentamicina intravenosa diária (6,6 mg/kg, 7 dias); metronidazol oral três vezes ao dia (15 mg/kg, 12 dias), seguido de mesma dose duas vezes ao dia, por mais 33 dias, totalizando 45 dias de tratamento. O fibrinogênio plasmático e o exame ultrassonográfico foram os recursos mais eficazes para a avaliação da evolução do abscesso. Após 24 horas do início do tratamento foi constatada a normalização do exame fisico, regressão progressiva da contagem de células nucleadas no líquido peritoneal, do fibrinogênio plasmático e do tamanho do abscesso. No 10° dia de tratamento o animal recebeu alta hospitalar, mantendo-se a terapia oral com metronidazol a cada 12 horas (15 mg/Kg). Em retorno, ao 30° dia, observou-se regressão do tamanho do abscesso, entretanto, não houve resolução, tendo sido mantida a terapia com metronidazol. No 45º dia de tratamento, realizou-se nova avaliação hospitalar, onde foi observada a resolução do abscesso e a admnistração do metronidazol foi suspensa. Destaca-se, que a associação terapêutica utilizada no tratamento de infecção abdominal e abscesso resultou em rápida resposta clínica.(AU)
Asunto(s)
Animales , Peritonitis/veterinaria , Ceftriaxona/administración & dosificación , Gentamicinas/administración & dosificación , Absceso Abdominal/veterinaria , Caballos , Metronidazol/administración & dosificación , Ultrasonido , Fibrinógeno , Inyecciones Intraperitoneales/veterinariaRESUMEN
Medical management of abdominal abscesses in horses requires prolonged antibiotic therapy and presents varied success rates. A 6-year-old male horse with a history of colic and multiple abdominal punctures to relieve gas was attended. At admission, tachycardia, tachypnea, hyperthermia, mucosal congestion, dehydration, and rigid gait were observed. The association of physical examination, laboratory and ultrasonographic findings allowed the diagnoses of peritonitis and abdominal abscess. Supporting treatment plus broad spectrum antibiotic therapy was performed: daily intraperitoneal ceftriaxone (25 mg/kg, 7 days); daily intravenous gentamicin (6.6 mg/kg, 7 days); per os metronidazole three times a day (15 mg/kg 12 days), followed by the same dose twice a day (15 mg/kg 33 days), totaling 45 days of treatment. Plasma fibrinogen and ultrasonographic examination were the most effective tools to evaluate abscess evolution. There was normalization of the physical examination 24 h after beginning the treatment, consecutive regression of the nucleated cell count in the peritoneal fluid, and regression of plasma fibrinogen and size of the abscess. On the 10th treatment day, the animal was discharged from the hospital, maintaining oral therapy with metronidazole every 12 h (15 mg / kg). When the animal returned on the 30th day, an abscess size regression was observed. However, there was no resolution, and therapy with metronidazole was maintained. On the 45th day of treatment, a new hospital evaluation was performed, where the abscess resolved, and metronidazole was suspended. It is highlighted that the therapeutic association used in the treatment of abdominal infection and abscess resulted in a rapid clinical response.(AU)
O tratamento conservativo dos abscessos abdominais em equinos requer antibioticoterapia prolongada e apresenta variadas taxas de sucesso. Foi atendido um cavalo de seis anos de idade, com histórico de cólica e múltiplas punções abdominais por agulha para esvaziamento de gás. Na admissão, foram observados taquicardia, taquipnéia, hipertermia, congestão mucosa, desidratação e marcha rígida. A associação do exame físico, achados laboratoriais e ultrassonográficos permitiu o diagnóstico de peritonite e abscesso abdominal. Foi realizado tratamento suporte e antibioticoterapia de amplo espectro: ceftriaxona intraperitoneal diária (25 mg/kg, 7 dias); gentamicina intravenosa diária (6,6 mg/kg, 7 dias); metronidazol oral três vezes ao dia (15 mg/kg, 12 dias), seguido de mesma dose duas vezes ao dia, por mais 33 dias, totalizando 45 dias de tratamento. O fibrinogênio plasmático e o exame ultrassonográfico foram os recursos mais eficazes para a avaliação da evolução do abscesso. Após 24 horas do início do tratamento foi constatada a normalização do exame fisico, regressão progressiva da contagem de células nucleadas no líquido peritoneal, do fibrinogênio plasmático e do tamanho do abscesso. No 10° dia de tratamento o animal recebeu alta hospitalar, mantendo-se a terapia oral com metronidazol a cada 12 horas (15 mg/Kg). Em retorno, ao 30° dia, observou-se regressão do tamanho do abscesso, entretanto, não houve resolução, tendo sido mantida a terapia com metronidazol. No 45º dia de tratamento, realizou-se nova avaliação hospitalar, onde foi observada a resolução do abscesso e a admnistração do metronidazol foi suspensa. Destaca-se, que a associação terapêutica utilizada no tratamento de infecção abdominal e abscesso resultou em rápida resposta clínica.(AU)
Asunto(s)
Animales , Peritonitis/veterinaria , Ceftriaxona/administración & dosificación , Gentamicinas/administración & dosificación , Absceso Abdominal/veterinaria , Caballos , Metronidazol/administración & dosificación , Ultrasonido , Fibrinógeno , Inyecciones Intraperitoneales/veterinariaRESUMEN
BACKGROUND: Nowadays about half of antibiotic prescriptions are inadequate, increasing bacterial resistance. Both cephalosporins and fluoroquinolones are associated with this phenomenon: increase of ß-lactamase producing bacteria and Clostridioides difficile infections, which is why regulatory agencies seek to rationalize their use. AIM: To evaluate the effect of use recommendations on the proportion of inadequate prescriptions of ceftriaxone and fluoroquinolones. METHODS: A prospective and interventional study was developed, comparing the quality and quantity of use of ceftriaxone and fluoroquinolones before and after the implementation of use recommendations for treatments of infectious diseases acquired at the community. The outcomes were: proportion of inadequate prescriptions and defined daily dose (DDD). Data were analyzed using the Chi-square test, Fisher's correction and Student's test. RESULTS: A total of 206 patients were evaluated, a 35% decrease in inadequate prescriptions, a decline in the consumption of ceftriaxone and levofloxacin, and a significant increase in the use of ampicillin/ sulbactam was observed. CONCLUSIONS: The implementation of use recommendations based on scientific evidence and local susceptibility allowed to reduce the proportion of inadequate prescriptions and to reduce de consumption of ceftriaxone and fluoroquinolones.
Asunto(s)
Antibacterianos/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos/normas , Ceftriaxona/administración & dosificación , Prescripciones de Medicamentos/normas , Fluoroquinolonas/administración & dosificación , Hospitales Universitarios/normas , Adulto , Anciano , Anciano de 80 o más Años , Esquema de Medicación , Utilización de Medicamentos/normas , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Prescripción Inadecuada/estadística & datos numéricos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Infectious meningitis is a medical emergency. Within the spectrum of infectious agents, the most important is Streptococcus pneumoniae, the most frequent etiological agent of bacterial meningitis. The initiation of empirical antimicrobial treatment bears great importance and considers third-generation cephalosporins as the first alternative. However, cases of ceftriaxone resistance have been reported in several regions of the world. This has become an emerging problem in need of reconsideration of the current empirical antibiotic treatment schemes. We present the case of a 56-year old man with acute infectious meningitis caused by ceftriaxone-resistant Streptococcus pneumoniae, who responded favorably to combined empirical treatment with ceftriaxone and vancomycin and to whom, during his hospital stay, the presence of hypothyroidism and mega cisterna magna was diagnosed.
La meningitis infecciosa es una emergencia médica. Dentro del espectro de agentes infecciosos, el más importante es el Streptococcus pneumoniae, agente etiológico más frecuente de la meningitis bacteriana. El inicio de tratamiento antimicrobiano empírico es de gran importancia y considera a las cefalosporinas de tercera generación como la primera alternativa. Sin embargo, casos de resistencia a ceftriaxona han sido reportados en diversas partes del mundo, siendo un problema emergente, por lo que necesita una reconsideración de los esquemas antibióticos empíricos actuales. Presentamos el caso de un varón de 56 años que presenta meningitis aguda infecciosa por Streptococcus pneumoniae resistente a ceftriaxona, que respondió favorablemente al tratamiento empírico combinado con ceftriaxona y vancomicina y que durante su estadía hospitalaria se detectó la presencia de hipotiroidismo y megacisterna magna.
Asunto(s)
Antibacterianos/administración & dosificación , Ceftriaxona/administración & dosificación , Meningitis Neumocócica/tratamiento farmacológico , Vancomicina/administración & dosificación , Farmacorresistencia Bacteriana , Quimioterapia Combinada , Humanos , Masculino , Meningitis Neumocócica/microbiología , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Streptococcus pneumoniae/aislamiento & purificación , Resultado del TratamientoRESUMEN
Introduction: Ceftriaxone has been recommended as a first-line treatment for various infections; however, the doses for pneumonia have not been a consensus in randomized clinical trials. To compare ceftriaxone 1 g daily efficacy to other ceftriaxone dosing regimens in community-acquired pneumonia. Area covered: We performed a systematic review and meta-analysis on PubMed, Web of Science, Scopus, and LILACS. Randomized controlled trials of ceftriaxone in community-acquired pneumonia were included. Outcomes included clinical cure in modified intention-to-treatment, clinically and microbiologically evaluable patients. Expert opinion: Ceftriaxone dosages of 1 g daily are as safe and effective as other antibiotic regimens for community-acquired pneumonia. Twenty-four articles fulfilled the inclusion criteria. Twelve studies evaluated ceftriaxone regimens at a dosage of 2 g daily and 12 studies evaluated ceftriaxone at a dosage of 1 g daily. The odds-ratio of clinical cure in the modified intention-to-treatment patients administered either ceftriaxone (4666 patients) or a comparator (4411 patients) was 0.98 (95% CI [0.82-1.17]). Comparator regimens showed similar efficacy to ceftriaxone regimens of 1 g daily, with an odds ratio of 1.03 (95% CI [0.88-1.20]). Dosages higher than ceftriaxone 1 g daily did not result in improved clinical outcomes for community-acquired pneumonia patients (OR 1.02, 95% CI [0.91-1.14]).
Asunto(s)
Antibacterianos/administración & dosificación , Ceftriaxona/administración & dosificación , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Neumonía/tratamiento farmacológico , Antibacterianos/efectos adversos , Ceftriaxona/efectos adversos , Relación Dosis-Respuesta a Droga , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
RESUMEN La meningitis infecciosa es una emergencia médica. Dentro del espectro de agentes infecciosos, el más importante es el Streptococcus pneumoniae, agente etiológico más frecuente de la meningitis bacteriana. El inicio de tratamiento antimicrobiano empírico es de gran importancia y considera a las cefalosporinas de tercera generación como la primera alternativa. Sin embargo, casos de resistencia a ceftriaxona han sido reportados en diversas partes del mundo, siendo un problema emergente, por lo que necesita una reconsideración de los esquemas antibióticos empíricos actuales. Presentamos el caso de un varón de 56 años que presenta meningitis aguda infecciosa por Streptococcus pneumoniae resistente a ceftriaxona, que respondió favorablemente al tratamiento empírico combinado con ceftriaxona y vancomicina y que durante su estadía hospitalaria se detectó la presencia de hipotiroidismo y megacisterna magna.
ABSTRACT Infectious meningitis is a medical emergency. Within the spectrum of infectious agents, the most important is Streptococcus pneumoniae, the most frequent etiological agent of bacterial meningitis. The initiation of empirical antimicrobial treatment bears great importance and considers third-generation cephalosporins as the first alternative. However, cases of ceftriaxone resistance have been reported in several regions of the world. This has become an emerging problem in need of reconsideration of the current empirical antibiotic treatment schemes. We present the case of a 56-year old man with acute infectious meningitis caused by ceftriaxone-resistant Streptococcus pneumoniae, who responded favorably to combined empirical treatment with ceftriaxone and vancomycin and to whom, during his hospital stay, the presence of hypothyroidism and mega cisterna magna was diagnosed.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Ceftriaxona/administración & dosificación , Vancomicina/administración & dosificación , Meningitis Neumocócica/tratamiento farmacológico , Antibacterianos/administración & dosificación , Streptococcus pneumoniae/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Resultado del Tratamiento , Farmacorresistencia Bacteriana , Quimioterapia Combinada , Meningitis Neumocócica/microbiologíaRESUMEN
Resumen Introduccion: Actualmente cerca de la mitad de las prescripciones de antimicrobianos son inadecuadas, lo que aumenta la resistencia bacteriana. Tanto cefalosporinas como fluoroquinolonas se asocian con este fenomeno: aumento de bacterias productoras de β-lactamasas e infecciones por Clostridioides difficile, por lo que las agencias reguladoras buscan racionalizar su uso. Objetivo: Evaluar el efecto de recomendaciones para el uso adecuado de antimicrobianos en la proporcion de prescripciones inadecuadas de ceftriaxona y fluoroquinolonas. Metodologia: Se desarrollo un estudio de antes y despues, prospectivo e intervencional, que comparo la calidad y la cantidad de uso de ceftriaxona y fluoroquinolonas antes y despues de la implementacion de recomendaciones de uso para tratamientos de enfermedades infecciosas adquiridas en la comunidad. Los parametros medidos fueron: proporcion de prescripciones inadecuadas y DDD. Los datos se analizaron por medio del test de χ2, correccion de Fisher y test de Student. Resultados: Se evaluaron 206 pacientes, observandose una disminucion de 35% en las prescripciones inadecuadas, una reduccion del consumo de ceftriaxona y levofloxacina y un aumento significativo de la utilizacion de ampicilina/sulbactam. Conclusiones: La implementacion de recomendaciones de uso basadas en evidencia cientifica y susceptibilidad local, permitieron disminuir la proporcion de prescripciones inadecuadas y reducir el consumo de ceftriaxona y fluoroquinolonas.
Background: Nowadays about half of antibiotic prescriptions are inadequate, increasing bacterial resistance. Both cephalosporins and fluoroquinolones are associated with this phenomenon: increase of β-lactamase producing bacteria and Clostridioides difficile infections, which is why regulatory agencies seek to rationalize their use. Aim: To evaluate the effect of use recommendations on the proportion of inadequate prescriptions of ceftriaxone and fluoroquinolones. Methods: A prospective and interventional study was developed, comparing the quality and quantity of use of ceftriaxone and fluoroquinolones before and after the implementation of use recommendations for treatments of infectious diseases acquired at the community. The outcomes were: proportion of inadequate prescriptions and defined daily dose (DDD). Data were analyzed using the Chi-square test, Fisher's correction and Student's test. Results: A total of 206 patients were evaluated, a 35% decrease in inadequate prescriptions, a decline in the consumption of ceftriaxone and levofloxacin, and a significant increase in the use of ampicillin/ sulbactam was observed. Conclusions: The implementation of use recommendations based on scientific evidence and local susceptibility allowed to reduce the proportion of inadequate prescriptions and to reduce de consumption of ceftriaxone and fluoroquinolones.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Prescripciones de Medicamentos/normas , Ceftriaxona/administración & dosificación , Fluoroquinolonas/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos/normas , Hospitales Universitarios/normas , Antibacterianos/administración & dosificación , Esquema de Medicación , Estudios Prospectivos , Resultado del Tratamiento , Utilización de Medicamentos/normas , Prescripción Inadecuada/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Tiempo de InternaciónRESUMEN
Resumo A doença de Lyme é uma infecção sistêmica causada pela espiroqueta Borrelia burgdorferi e transmitida pelo carrapato do gênero Ixodes sp. e espécie Amblyomma cajennense. A doença costuma se manifestar em três estágios clínicos distintos, que podem variar de acordo com as características de cada hospedeiro. O objetivo deste trabalho é relatar o caso de uma paciente de 33 anos com doença de Lyme que apresentou como manifestações neuroftalmológicas diplopia, lagoftalmo paralítico e ceratite punctata, com exames laboratoriais negativos. Embora a espiroqueta Borrelia burgdorferi tenha maior tropismo pelos tecidos da pele, sistema nervoso e articulações, o acometimento ocular não deve ter sua importância diminuída, sendo descrito neste relato de caso, que abordou os aspectos mais pertinentes à doença para auxiliar seu diagnóstico e tratamento.
Abstract Lyme disease is a systemic infection caused by the spirochete Borrelia burgdorferi and transmitted by the tick of the genus Ixodes sp. and species Amblyomma cajennense. The disease usually manifests itself in three distinct clinical stages, which may vary according to the characteristics of each host. The objective of this paper is to report the case of a 33-year-old patient with Lyme disease who presented as neuro-ophthalmological manifestations diplopia, paralytic lagophthalmos and punctate keratitis, with negative laboratory tests. Although the spirochete Borrelia burgdorferi has a greater tropism in the tissues of the skin, nervous system and joints, the ocular involvement should not be diminished, being described in this case report, which approached the most pertinent aspects to the disease to aid its diagnosis and treatment.
Asunto(s)
Humanos , Femenino , Adulto , Enfermedad de Lyme/complicaciones , Diplopía/etiología , Oftalmopatías/etiología , Parálisis Facial/etiología , Infecciones por Borrelia/transmisión , Ceftriaxona/administración & dosificación , Enfermedad de Lyme/diagnóstico , Enfermedad de Lyme/tratamiento farmacológico , Grupo Borrelia Burgdorferi/aislamiento & purificación , Ixodes , Neuroborreliosis de Lyme/complicaciones , Amblyomma , Enfermedades del Sistema Nervioso/etiologíaRESUMEN
OBJECTIVE: The present study assessed epidemiological and obstetrical data from pregnant women with syphilis at the Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro (UFTM, in the Portuguese acronym), describing this disease during pregnancy and its vertical transmission for future healthcare actions. METHODS: Records from pregnant women who had been admitted to the Obstetrics Department of the Hospital de Clínicas of the UFTM and were diagnosed with syphilis between 2007 and 2016 were reviewed. A standardized form was used to collect epidemiological, obstetric data and outcomes of congenital infection. The present research has been authorized by the Ethics Committee of the institution. RESULTS: There were 268 women diagnosed with syphilis, with an average age of 23.6 years old. The majority of the patients were from Uberaba. Inadequate prenatal care was observed in 37.9% of the pregnant women. Only 34.2% of the patients completed the treatment according to the guidelines issued by the Ministry of Health of Brazil, and 19.8% of the partners of the patients underwent adequate syphilis treatment; 37 (13.8%) couples (patients and partners) underwent correct treatment. Regarding the obstetric outcomes, 4 (1.5%) patients had a miscarriage and 8 (3.4%) had fetal losses (from the fetal loss group, 7 had no adequate treatment); 61 (25.9%) patients had premature births - this prematurity has been significantly correlated to inadequate or incomplete treatment in 49 (27.9%) patients, compared with 12 (13.0%) patients with premature births and adequate treatment (p = 0.006). The average live newborn weight was 2,840 g; 25.3% had a birth weight < 2,500 g; 74.2% had congenital syphilis, a data with heavy correlation to inadequate or incomplete prenatal care, prematurity, and low birth weight. CONCLUSION: Public awareness policies on adequate prenatal care, intensification of serological screening, and early treatment of syphilis are needed, considering the rise of cases diagnosed during gestation and its potentially preventable deleterious consequences related to congenital transmission.
OBJETIVO: O presente estudo avaliou dados epidemiológicos e obstétricos de gestantes com sífilis no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro (UFTM), objetivando o conhecimento desta infecção no ciclo gravídico e a transmissão vertical para futuras ações em saúde pública. MéTODOS:: Foram revisados registros de gestantes admitidas no Departamento de Ginecologia e Obstetrícia do Hospital de Clínicas da UFTM, diagnosticadas com sífilis entre 2007 e 2016. Para a coleta de dados, utilizou-se um formulário padronizado enfocando aspectos epidemiológicos, obstétricos e infecção congênita. A presente pesquisa foi autorizada pelo Comitê de Ética da instituição. RESULTADOS: Obteve-se 268 gestantes diagnosticadas com sífilis, com idade media de 23,6 anos, sendo a maioria de Uberaba. A assistência pré-natal foi inadequada em 37,9% dos casos. O tratamento para sífilis, de acordo com as diretrizes do Ministério da Saúde do Brasil, foi realizado por 34,2% das gestantes e por 19,8% dos parceiros. Quanto aos desfechos obstétricos, observou-se que 4 (1,5%) pacientes evoluíram com abortamento e 8 (3,4%) com óbito fetal, das quais 7 não realizaram tratamento. Observou-se parto prematuro em 61 (25,9%) gestantes, e a prematuridade foi significativamente associada ao tratamento ausente/incompleto, com 49 (27,9%) casos, comparada a 12 (13,0%) casos nos quais o tratamento foi adequado (p = 0,006). Quanto aos recém-nascidos, o peso médio foi de 2.840 g, e 25,3% apresentaram peso < 2.500 g. Diagnosticou-se infecção congênita em 74,2%, dos casos, associada significativamente ao pré-natal inadequado, ao tratamento ausente/incompleto, à prematuridade e ao baixo peso ao nascer. CONCLUSãO:: Políticas públicas de conscientização sobre pré-natal adequado, intensificação de rastreamento sorológico e tratamento precoce da sífilis são necessárias, haja vista a ascensão dos casos diagnosticados na gestação e suas consequências deletérias potencialmente evitáveis relacionadas à transmissão congênita.
Asunto(s)
Complicaciones Infecciosas del Embarazo/epidemiología , Sífilis/epidemiología , Antibacterianos/administración & dosificación , Brasil/epidemiología , Ceftriaxona/administración & dosificación , Esquema de Medicación , Femenino , Hospitalización/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Humanos , Recién Nacido , Masculino , Penicilina G Benzatina/administración & dosificación , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Diagnóstico Prenatal , Pronóstico , Estudios Retrospectivos , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Sífilis Congénita/tratamiento farmacológico , Sífilis Congénita/epidemiología , Resultado del Tratamiento , Adulto JovenRESUMEN
Abstract Objective: The present study assessed epidemiological and obstetrical data from pregnant women with syphilis at the Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro (UFTM, in the Portuguese acronym), describing this disease during pregnancy and its vertical transmission for future healthcare actions. Methods: Records from pregnant women who had been admitted to the Obstetrics Department of the Hospital de Clínicas of the UFTM and were diagnosed with syphilis between 2007 and 2016 were reviewed. A standardized form was used to collect epidemiological, obstetric data and outcomes of congenital infection. The present research has been authorized by the Ethics Committee of the institution. Results: There were 268 women diagnosed with syphilis, with an average age of 23.6 years old. The majority of the patients were from Uberaba. Inadequate prenatal care was observed in 37.9% of the pregnant women. Only 34.2% of the patients completed the treatment according to the guidelines issued by the Ministry of Health of Brazil, and 19.8% of the partners of the patients underwent adequate syphilis treatment; 37 (13.8%) couples (patients and partners) underwent correct treatment. Regarding the obstetric outcomes, 4 (1.5%) patients had a miscarriage and 8 (3.4%) had fetal losses (from the fetal loss group, 7 had no adequate treatment); 61 (25.9%) patients had premature births - this prematurity has been significantly correlated to inadequate or incomplete treatment in 49 (27.9%) patients, compared with 12 (13.0%) patients with premature births and adequate treatment (p = 0.006). The average live newborn weight was 2,840 g; 25.3% had a birth weight < 2,500 g; 74.2% had congenital syphilis, a data with heavy correlation to inadequate or incomplete prenatal care, prematurity, and low birth weight. Conclusion: Public awareness policies on adequate prenatal care, intensification of serological screening, and early treatment of syphilis are needed, considering the rise of cases diagnosed during gestation and its potentially preventable deleterious consequences related to congenital transmission.
Resumo Objetivo: O presente estudo avaliou dados epidemiológicos e obstétricos de gestantes com sífilis no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro (UFTM), objetivando o conhecimento desta infecção no ciclo gravídico e a transmissão vertical para futuras ações em saúde pública. Métodos: Foram revisados registros de gestantes admitidas no Departamento de Ginecologia e Obstetrícia do Hospital de Clínicas da UFTM, diagnosticadas com sífilis entre 2007 e 2016. Para a coleta de dados, utilizou-se um formulário padronizado enfocando aspectos epidemiológicos, obstétricos e infecção congênita. A presente pesquisa foi autorizada pelo Comitê de Ética da instituição. Resultados: Obteve-se 268 gestantes diagnosticadas com sífilis, com idade media de 23,6 anos, sendo a maioria de Uberaba. A assistência pré-natal foi inadequada em 37,9% dos casos. O tratamento para sífilis, de acordo com as diretrizes do Ministério da Saúde do Brasil, foi realizado por 34,2% das gestantes e por 19,8% dos parceiros. Quanto aos desfechos obstétricos, observou-se que 4 (1,5%) pacientes evoluíram com abortamento e 8 (3,4%) com óbito fetal, das quais 7 não realizaram tratamento. Observou-se parto prematuro em 61 (25,9%) gestantes, e a prematuridade foi significativamente associada ao tratamento ausente/incompleto, com 49 (27,9%) casos, comparada a 12 (13,0%) casos nos quais o tratamento foi adequado (p = 0,006). Quanto aos recém-nascidos, o peso médio foi de 2.840 g, e 25,3% apresentaram peso < 2.500 g. Diagnosticou-se infecção congênita em 74,2%, dos casos, associada significativamente ao pré-natal inadequado, ao tratamento ausente/ incompleto, à prematuridade e ao baixo peso ao nascer. Conclusão: Políticas públicas de conscientização sobre pré-natal adequado, intensificação de rastreamento sorológico e tratamento precoce da sífilis são necessárias, haja vista a ascensão dos casos diagnosticados na gestação e suas consequências deletérias potencialmente evitáveis relacionadas à transmissão congênita.