Assuntos
Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae/imunologia , Adolescente , Distribuição por Idade , Anticorpos Antibacterianos/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Colômbia/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Incidência , Lactente , Masculino , Minnesota/epidemiologia , Infecções Pneumocócicas/sangue , Estudos SoroepidemiológicosRESUMO
OBJECTIVE: To reconcile conflicting published reports concerning the absolute and comparative clinical efficacy of antimicrobial drugs for acute otitis media in children. STUDY SELECTION: Articles were identified by MEDLINE search, Current Contents, and references from review articles, textbook chapters, and retrieved reports. Randomized, controlled trials of therapeutic antimicrobial drugs used in the initial empiric therapy for simple acute otitis media were selected by independent, blinded observers, and scored on 11 measures of study validity. Thirty English and three foreign-language articles met all inclusion criteria. DATA EXTRACTION: Data were abstracted for an end point of complete clinical resolution (primary control), exclusive of middle ear effusion, within 7 to 14 days after therapy started. DATA SYNTHESIS: The spontaneous rate of primary control--without antibiotics or tympanocentesis--was 81% (95% confidence interval, 69% to 94%). Compared with placebo or no drug, antimicrobial therapy increased primary control by 13.7% (95% confidence interval, 8.2% to 19.2%). No significant differences were found in the comparative efficacy of various antimicrobial agents. Extending antimicrobial coverage to include beta-lactamase-producing organisms did not significantly increase the rates of primary control or resolution of middle ear effusion. Pretreatment tympanocentesis was positively associated with individual group primary control rates, negatively associated with the ability to detect differences in clinical efficacy and unassociated with resolution of MEE. CONCLUSIONS: Antimicrobial drugs have a modest but significant impact on the primary control of acute otitis media. Treatment with beta-lactamase-stable agents does not increase resolution of acute symptoms or middle ear effusion; initial therapy should be guided by considerations of safety, tolerability, and affordability, and not by the theoretical advantage of an extended antibacterial spectrum.
Assuntos
Antibacterianos/uso terapêutico , Otite Média/tratamento farmacológico , Doença Aguda , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Análise Multivariada , Ensaios Clínicos Controlados Aleatórios como Assunto , Sensibilidade e EspecificidadeRESUMO
No single antimicrobial drug is best suited for all patients with AOM. Amoxicillin and TMP-SMZ, however, remain first-line drugs in the initial treatment of uncomplicated AOM in the non-neonate. In other situations the drug selected depends on the patient's age, associated illnesses, recent history of otitis media, and drug hypersensitivity. Pharmacokinetic studies of AOM treatment are essential in generating more precise recommendations for antimicrobial drug use.
Assuntos
Anti-Infecciosos/uso terapêutico , Otite Média/tratamento farmacológico , Doença Aguda , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/farmacocinética , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Otite Média/diagnóstico , RecidivaRESUMO
Bacteremia in young children seen in the outpatient clinic is a reasonably frequent occurrence with occasionally serious sequelae; most patients, however, do quite well. The problem is more perplexing in infants and young children with high fever and no apparent focus of infection. Laboratory tests and clinical observations help to determine which children are at low risk of occult bacteremia and need not have blood cultured; testing and assessment are much less predictive of the child who does have occult bacteremia. Currently, it is unclear whether treating all patients at risk is warranted. In any case, very close follow-up of the patient who is sent home from the outpatient department with high fever is desirable. The prevalence of serious infections caused by pneumococcus, Hib, and meningococcus warrants continued research on the development of vaccines that effectively prevent these infections.
Assuntos
Sepse/diagnóstico , Antibacterianos/uso terapêutico , Pré-Escolar , Feminino , Febre/etiologia , Humanos , Lactente , Contagem de Leucócitos , Masculino , Meningite/diagnóstico , Meningite/etiologia , Sepse/tratamento farmacológico , Sepse/imunologia , Sepse/microbiologia , Punção Espinal/efeitos adversosRESUMO
Asplenic persons are at increased risk of overwhelming sepsis caused by Streptococcus pneumoniae. Vaccination with polyvalent pneumococcal polysaccharide has been shown to stimulate a nearly normal antibody response in these individuals, indicating that active vaccination might prevent pneumococcal disease in this population. To obtain information on the duration of protective levels of pneumococcal antibody, 33 asplenic children were vaccinated and antibody levels were measured at intervals for up to 4 1/2 years after vaccination. Significant antibody decline was observed in children who had undergone splenectomy because of trauma, but antibody decline was not observed in children whose spleens had been removed because of hereditary spherocytosis. There was a highly significant difference in rates of antibody decline among the 12 antibody serotypes measured: types 1, 4, 6A, 7F, 8, 19F, and 23F showed the greatest decline. Based on measured rates of antibody decline, subprotective antibody levels (antibody nitrogen less than 300 ng/ml) for types 7F, 8, and 19F would be reached 1 to 2 years after vaccination; type 6A never reached the protective level; and antibodies against the remaining eight types either were within the protective range initially or did not show significant decline. Asplenic children may benefit from revaccination with certain antigen types (7F, 8, and 19F) 1 to 2 years after initial vaccination.
Assuntos
Anticorpos Antibacterianos/análise , Vacinas Bacterianas , Infecções Pneumocócicas/prevenção & controle , Polissacarídeos Bacterianos/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Esplenectomia , Streptococcus pneumoniae/imunologia , Adolescente , Criança , Pré-Escolar , Humanos , Infecções Pneumocócicas/imunologia , Polissacarídeos Bacterianos/imunologia , Complicações Pós-Operatórias/imunologia , Baço/lesõesRESUMO
Depressed PMN chemotactic responsiveness was observed in 17.5% of 97 patients studied, depressed PMN bactericidal activity in 23.3% of 30 patients, and depressed PMN chemiluminescence activity in 15.8% of 19 patients. Depressed chemotactic