RESUMO
AIM: Toenail fungal infections account for half of all nail disease cases, and a highly negative impact on patient quality of life. Our aim was to compare the efficacy and safety of commercially available oral antifungals for onychomycosis. METHODS: A systematic review was performed in PubMed and Scopus. Randomized controlled trials evaluating the effect of oral antifungals on mycological cure, discontinuation and adverse events were included. Network meta-analyses were built for each outcome. Results were reported as odds ratios (OR) with 95% credibility intervals (CrI). Ranking probabilities were calculated by surface under the cumulative ranking analysis (SUCRA). RESULTS: We included 40 trials (n = 9568). Albaconazole 400 mg (OR 0.02 [95% CrI 0.01-0.07] versus placebo), followed by posaconazole 200-400 mg and terbinafine 250-350 mg were considered the best therapies (SUCRA probabilities over 75%). For the networks of discontinuation and individual adverse events, few significant differences among treatments were observed, but itraconazole 400 mg was considered the safest drug (SUCRA around 25%). Albaconazole 400 mg, posaconazole 200-400 mg, and terbinafine 250-350 mg were the most effective therapies for onychomycosis, while itraconazole 400 mg was the safest. CONCLUSION: The profile of albaconazole and posaconazole compared to current first-line therapies should be further investigated in well-designed trials.
Assuntos
Dermatoses do Pé , Onicomicose , Antifúngicos/uso terapêutico , Dermatoses do Pé/tratamento farmacológico , Humanos , Itraconazol/uso terapêutico , Unhas , Metanálise em Rede , Onicomicose/tratamento farmacológico , Qualidade de Vida , Resultado do TratamentoRESUMO
The occurrence of antibiotics in the natural environment has been a growing issue and correlations between this presence and developing resistance bacteria are explored. The purpose of this study was to investigate the presence of antibiotics of different classes and associated resistant bacteria, in water samples taken from urban river waters in Curitiba, Brazil. A method for the quantification of antibiotics (azithromycin, amoxicillin, norfloxacin ciprofloxacin, doxycycline and sulfamethoxazole) was developed and validated using liquid chromatography coupled with mass spectrometry. To investigate and identify coliforms resistant to these antibiotics, we performed selective microbiological culturing techniques. We detected antibiotics in our water samples; concentrations ranged from 0.13 to 4.63 µg L-1, with the highest being amoxicillin at 4.63 µg L-1. In all water samples this study, antibiotic resistant bacteria were detected. Escherichia coli was resistant to amoxicillin, norfloxacin, ciprofloxacin, doxycycline and sulfamethoxazole. Strains producing ß-lactamase with extended spectrum (ESBL and AmpC) were also found in these isolates. Enterococcus spp. displayed resistance to norfloxacin and ciprofloxacin, and some isolates were resistant to vancomycin, gentamicin and streptomycin (complementary tests). No P. aeruginosa resistant strains were observed. It is possible these antibiotics came from domestic effluents and may be contributing to the spread of bacterial resistance.