RESUMO
La clindamicina es un antibiótico de amplio espectro con actividad contra los aerobios grampositivos y una extensa gama de bacterias anaerobias, entre ellas los patógenos productores de betalactamasa. Los estudios in vitro e in vivo han demostrado que este fármaco alcanza una concentración elevada en el punto de infección, reduce la virulencia de las bacterias y refuerza las actividades fagocíticas de los linfocitos inmunitarios del huésped. La clindamicina por vía oral se absorbe con rapidez y eficacia, y su concentración permanece por encima de la concentración inhibidora mínima de la mayoría de los organismos por lo menos durante 6 horas. En este análisis, presentaremos pruebas de la eficacia e inocuidad de la clindamicina en el tratamiento de las infecciones odontogénicas con datos de estudios preclínicos y clínicos, los cuales avalan la aplicación general de este antibiótico como antiinfeccioso en el campo de la odontología.
Clindamycin is an antibiotic of wide range of action with a great activity against aerobic gram-positive germs and a broad spectrum of anaerobic bacteria, among which we can find the pathogenic agents that produce Beta-lactamase. The in vitro and in vivo have shown that this medicine reaches a high concentration at the infection point, reduces the bacteria virulence, and strengthens the phagocytic activity of the immunizing lymphocyte of the host. Clindamycin through oral ingestion is absorbed very quickly and effectively, and its concentration remains the same above the minimum inhibitory concentration of most of the organisms at least for six hours. In this analysis, we will introduce some proofs about the effectiveness and innocuousness of clindamycin in the treatment of odontogenic infections. This data is based upon clinical and pre-clinical studies that support the general use of this mentioned antibiotic as an anti-infectious agent in the field of odontology.
Assuntos
Clindamicina/farmacologia , Clindamicina/uso terapêutico , Infecção Focal Dentária/diagnóstico , Infecção Focal Dentária/terapia , Ampicilina/uso terapêutico , Doenças Periodontais/terapia , Relatório de Pesquisa , Penicilina V/uso terapêutico , Profilaxia Dentária , Interpretação Estatística de DadosRESUMO
The healing of standardized bone defects grafted with either particulate ionomeric or hydroxyapatite bone substitutes was compared in the mandibular ramus of 30 Sprague-Dawley rats. The possible additional response achieved when combining these materials with a guided bone regeneration (GBR) technique was also evaluated. Three groups of 10 animals received either no implant material or ionomeric or hydroxyapatite bone substitute in defects in the right ramus. The left mandibular defects received the same treatment, except that the operation site was covered by a membrane (GBR technique). Half of the animals were sacrificed at 4 and 10 weeks following surgery, and the inflammatory response at the implant site and the amount of new bone formed in the defects were determined histomorphometrically. Defects implanted with ionomeric bone substitute exhibited more bone formation (4 weeks = 3.19 +/- 0.35 mm2, 10 weeks = 5.35 +/- 0.26 mm2) than both defects that received no treatment (4 weeks = 0.88 +/- 0.35 mm2, 10 weeks = 2.1 +/- 0.49 mm2), membrane alone (4 weeks = 1.21 +/- 0.05 mm2) or hydroxyapatite bone substitute (4 weeks = 1.41 +/- 0.46 mm2, 10 weeks = 3.34 +/- 0.41 mm2) at 4 weeks (P < or = .01) and at 10 weeks (P < or = .05). The use of a GBR technique did not increase the amount of bone formed, compared to the use of bone substitutes alone. Hydroxyapatite and ionomeric bone substitutes used alone were more effective in inducing repair of the defects than was GBR membrane alone. The use of hydroxyapatite was associated with a greater inflammatory reaction (P < or = .01) than was ionomer in this model.
Assuntos
Regeneração Óssea , Substitutos Ósseos , Próteses e Implantes , Análise de Variância , Animais , Durapatita , Cimentos de Ionômeros de Vidro , Regeneração Tecidual Guiada/métodos , Masculino , Mandíbula/cirurgia , Ratos , Ratos Sprague-Dawley , Estatísticas não Paramétricas , CicatrizaçãoRESUMO
Repeated aspirations (for a period of 36 to 55 days) of the exudate through an open perforation were performed in seven children with acute otitis media that did not respond to antimicrobial therapy. Penicillin-resistant organisms were present in all but one of the first two aspirates. Failure to respond to antimicrobial therapy was associated with the emergence of resistant anaerobic and aerobic bacteria in the third and fourth cultures. The infection was cured in all instances after administration of antimicrobial agents effective against these bacteria.
Assuntos
Antibacterianos/uso terapêutico , Otite Média com Derrame/diagnóstico , Otite Média com Derrame/tratamento farmacológico , Adolescente , Bactérias Anaeróbias/patogenicidade , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Feminino , Humanos , Lactamas , Masculino , Otite Média com Derrame/etiologiaRESUMO
Because production of beta-lactamase by normal pharyngeal flora could account for penicillin treatment failure, we studied the effect of anaerobic and aerobic beta-lactamase-producing bacteria on bacteriologic outcome in acute group A beta-hemolytic streptococcal (GABHS) pharyngitis. We compared 10-day courses of orally administered phenoxymethyl penicillin and amoxicillin-clavulanic acid, using a randomized, single-blind treatment protocol. Eligible patients were 2 to 16 years of age and had culture-proven acute GABHS pharyngitis; 89 patients (43 penicillin, 46 amoxicillin-clavulanic acid) were compliant with therapy. beta-Lactamase-producing organisms were isolated before therapy from the throats of 67% of patients treated with penicillin and 63% treated with amoxicillin-clavulanic acid. Throat cultures after completion of therapy were positive for GABHS in 7 (7.9%) of 89 patients. The initial GABHS T type persisted (treatment failure) in only 4 (4.5%) of 89 patients, including 3 (6.5%) of 46 who received amoxicillin-clavulanic acid and in 1 (2.3%) of 43 who received penicillin (not statistically significant). Bacteriologic treatment failure was unrelated to recovery of beta-lactamase-producing bacteria at the time of enrollment or after treatment. We conclude that beta-lactamase production by normal pharyngeal flora does not fully explain the failure of penicillin therapy for acute streptococcal pharyngitis. Using an antibiotic effective against beta-lactamase-producing bacteria will not eliminate the problem of bacteriologic treatment failure.
Assuntos
Amoxicilina/uso terapêutico , Ácidos Clavulânicos/uso terapêutico , Penicilina V/uso terapêutico , Faringite/microbiologia , Faringe/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes , beta-Lactamases/biossíntese , Adolescente , Amoxicilina/administração & dosagem , Combinação Amoxicilina e Clavulanato de Potássio , Bactérias Aeróbias/classificação , Bactérias Anaeróbias/classificação , Criança , Pré-Escolar , Ácidos Clavulânicos/administração & dosagem , Quimioterapia Combinada/administração & dosagem , Quimioterapia Combinada/uso terapêutico , Humanos , Penicilina V/administração & dosagem , Faringite/tratamento farmacológico , Sorotipagem , Método Simples-Cego , Infecções Estreptocócicas/tratamento farmacológico , beta-Lactamases/farmacologiaRESUMO
Seventy-four transtracheal aspirations and expectorated sputum specimens were collected from a number of children with aspiration pneumonia. The aspirates were cultured for aerobic and anaerobic bacteria. Cultures obtained through TTA contained fewer pathogens than in cultures of expectorated sputum. Gram stains of TTA aspirates offered prompt presumptive bacteriologic diagnosis in 93% of patients, whereas Gram stains of expectorated sputum were not specific. The recovery of Gram-negative enteric rods in the TTA aspirate provided guidance in adding an aminoglycoside to the antimicrobial therapy in 35 children (47%). Side effects of TTA included mild hemoptysis and, in rare instances, subcutaneous emphysema. We found TTA to be a generally safe and useful procedure in the diagnosis and therapy of aspiration pneumonia in children.
Assuntos
Pneumonia Aspirativa/diagnóstico , Sucção/métodos , Adolescente , Antibacterianos/uso terapêutico , Bactérias/isolamento & purificação , Técnicas Bacteriológicas , Criança , Pré-Escolar , Exsudatos e Transudatos/microbiologia , Feminino , Humanos , Lactente , Masculino , Pneumonia Aspirativa/tratamento farmacológico , Pneumonia Aspirativa/microbiologia , Escarro/microbiologia , Sucção/efeitos adversos , TraqueiaRESUMO
The bacteriology and clinical findings of ten pediatric patients with lung abscess are presented. Bacteriologic data were based on percutaneous transtracheal aspiration obtained before initiation of antimicrobial therapy. Anaerobic bacteria were present in all ten patients; in nine they were mixed with aerobic bacteria. The most frequent isolates were Peptostreptococcus (8), Peptococcus (5), Bacteroides melaninogenicus (6), and Bacteroides fragilis (3). The aerobic isolates most frequently recovered were alpha-hemolytic streptococci (5), group A beta-hemolytic streptococci (4), and Escherichia coli and Klebsiella pneumoniae (4 each). Virtually all abscesses were located in dependent pulmonary segments. Antimicrobial therapy was guided by the bacteriologic findings and was successful in all instances.
Assuntos
Bactérias/isolamento & purificação , Abscesso Pulmonar/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Abscesso Pulmonar/tratamento farmacológico , Abscesso Pulmonar/etiologia , MasculinoRESUMO
Tympanocentesis and aerobic and anaerobic cultivation of the middle-ear fluid obtained was performed through one or both tympanic membranes of 62 children with acute otitis media. Aerobic bacteria alone, predominantely pneumococcus and Hemophilus influenzae, were isolated from 57% of patients; anaerobic organisms alone, most commonly Propionibacterium acnes and Peptococcus, from 15%. Thirteen percent yielded mixtures of aerobes and anaerobes, and several had multiple aerobic or anaerobic agents. The isolation of only anaerobic bacteria, supported in some patients by gram-stain observations of middle-ear fluid, suggest that these bacteria, especially Petococcus, may occasionally play a direct role in acute otitis media.