RESUMO
A University-based hospital in Bogotá, Colombia, developed and implemented an educational intervention to complement a new structured antibiotic order form. This intervention was performed after assessing the appropriateness of the observed antibiotic prescribing practices using a quasi-experimental study. An application of interrupted time series intervention analysis was conducted in three antibiotic groups (aminoglycosides, cephradine/cephalothin, and ceftazidime/cefotaxime) and their hospital weekly rate of incorrect prescriptions before and after the intervention. A fourth time series was defined on prophylactic antibiotic use in elective surgery. Preintervention models were used in the postintervention series to test for pre-post series level differences. An abrupt constant change was significant in the first, third, and fourth time series indicating a 47, 7.3, and 20% reduction of incorrect prescriptions after the intervention. We conclude that a structured antibiotic order form, coupled with graphic and educational interventions can improve antibiotic use in a university hospital.
Assuntos
Antibacterianos/administração & dosagem , Competência Clínica , Prescrições de Medicamentos/normas , Revisão de Uso de Medicamentos/métodos , Hospitais de Ensino/normas , Aminoglicosídeos/administração & dosagem , Antibioticoprofilaxia/normas , Cefazolina/administração & dosagem , Cefradina/administração & dosagem , Colômbia , Países em Desenvolvimento , Educação Médica Continuada , Grupos Focais , Formulários de Hospitais como Assunto/normas , Humanos , Corpo Clínico Hospitalar/educação , Modelos EstatísticosRESUMO
OBJECTIVE: We studied the feasibility of treating breast abscesses with sonographically guided aspiration, irrigation, and local instillation of antibiotics without placing indwelling catheters. MATERIALS AND METHODS: Seventy-three patients with breast abscesses were seen from 1995 to 2001. Aspiration and irrigation were performed under sonographic guidance. Repeated aspiration was performed when deemed necessary. One gram of cephradine was injected into 29 abscesses measuring more than 25 mm. RESULTS: Six patients refused further treatment after failure of the first aspiration and elected surgical drainage. Of the remaining 67 patients who completed treatment, 38 required one aspiration for cure, 18 required two aspirations, and eight required more than two aspirations. The treatment failed and surgical drainage was required in only three of the 67 patients completing treatment. CONCLUSION: Ninety-six percent of patients completing treatment were cured with this procedure. Local instillation of antibiotics is probably beneficial.
Assuntos
Abscesso/terapia , Antibacterianos/administração & dosagem , Doenças Mamárias/terapia , Cefradina/administração & dosagem , Abscesso/diagnóstico por imagem , Adolescente , Adulto , Idoso , Doenças Mamárias/diagnóstico por imagem , Feminino , Humanos , Instilação de Medicamentos , Pessoa de Meia-Idade , Sucção/métodos , Irrigação Terapêutica , UltrassonografiaRESUMO
Antecedentes. La embarazada desarrolla fácilmente infecciones de la vía urinaria por cambios funcionales y por ubicación del meato uretral. En la pielonefritis aguda del embarazo no es muy conocida la participación de la infección del tracto genital inferior en los resultados del tratamiento antibiótico y en la presencia de contracción uterina del aborto y parto prematuro. Objetivos. Conocer la microbiología de la vía uterina y del tracto genital en la pielonefritis aguda del embarazo y su relación con los resultados del tratamiento y con la existencia de contracción uterina. Diseño del estudio. Embarazada entre 12 y 34 semanas de gestación con el diagnóstico de pielonefritis aguda se enrolaron. Se tomaron muestras de orina y cervicovaginales para cultivo. Recibieron randomizadamente cefuroxima o cefradina. Se observó la contracción uterina. En el seguimiento se pidieron cultivos de orina como controles. Resultados. 97 mujeres cumplieron con los criterios de inclusión. Escherichia coli se aisló del urocultivo en el 94,8 por ciento de los casos. La vaginosis bacteriana se presentó en el 32,0 por ciento y la infección cervicovaginal en el 57,7 por ciento de las pacientes. En la infección cervicovaginal E. coli se aisló en el 65,2 por ciento. El fracaso en la erradicación de la bacteria de la vía urinaria, se asoció con infección cervicovaginal (76,9 por ciento vs 52,9 por ciento, p< 0.05) y con leucocitos aumentados en la muestra cervical (76,9 por ciento vs 47,1 por ciento, p< 0,01). La contracción uterina se asoció significativamente con: infección cervicovaginal (p < 0,01), vaginosis bacteriana (p < 0,001) y con hallazgo en la muestra cervical de : leucocitos aumentados (p < 0,01), flora polimicrobiana (p < 0,001), aislamiento de E. coli (p < 0.001) y disminución de Lactobacillus sp (p < 0.01). Conclusiones: La infección del tracto genital inferior existente en la pielonefritis aguda del embarazo se relaciona con el fracaso de la terapia antimicrobiana en la erradicación de la bacteria de la vía urinaria y con contracción uterina presente
Assuntos
Humanos , Feminino , Gravidez , Adulto , Adolescente , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/microbiologia , Pielonefrite/microbiologia , Doenças do Colo do Útero/microbiologia , Aborto Espontâneo/epidemiologia , Cefuroxima/administração & dosagem , Cefradina/administração & dosagem , Contração Uterina , Trabalho de Parto Prematuro/epidemiologia , Pielonefrite/complicações , Doenças do Colo do Útero/complicações , Vaginose Bacteriana/microbiologiaRESUMO
La cefradina es una cefalosporina semisintética de primera generación, eficaz contra la mayoría de bacterias gram positivas y gram negativas, que puede ser administrada por vía parenteral y oral. Este estudio se realizó en 52 pacientes con lesión de cadera que ameritaba corrección quirúrgica. Desde el postoperatorio inmediato y durante tres días se administró 1 g de cefradina por vía endovenosa cada 12 horas, y en los siete días posteriores se continuó con 500 mg por vía oral cada 12 horas. No se administraron dosis pre o intraoperatorias. Sólo en tres casos se presentó eritema persistente en la periferia de la herida quirúrgica, que cedió al séptimo día postoperatorio, por lo que no fue necesario alterar el protocolo de estudio. Los resultados de esta investigación mostraron que la cefradina es una excelente opción terapéutica para cirugías de gran calibre debido a que no requiere combinaciones o modificaciones bruscas en la antibioticoterapia y ofrece un bajo índice de complicaciones
Assuntos
Humanos , Masculino , Feminino , Cefradina/administração & dosagem , Quadril/cirurgiaRESUMO
Se presenta la experiencia personal en el tratamiento de la colelitiasis por vía laparoscópica sin neumoperitoneo. Entre enero de 1993 y septiembre de 1994 se realizaron un total de 50 colecistectomías. Se describe la técnica quirúrgica y los instrumentos utilizados para el procedimiento. Las edades fluctuaron entre 24 y 69 años; se operaron 14 hombres y 36 mujeres. La media del tiempo operatorio fue de 63 minutos con un margen de 30 a 90 min., la estadía hospitalaria media fue de 2 días. No se presentaron complicaciones operatorias ni postoperatorias con esta técnica
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Colelitíase/cirurgia , Colecistectomia Laparoscópica/métodos , Cefradina/administração & dosagem , Pneumoperitônio Artificial/estatística & dados numéricos , Pré-Medicação/métodosRESUMO
The pharmacokinetics of IV and oral cephradine in healthy young male and female volunteers (ages 19 to 25, n = 10) were compared to those of older individuals (ages 65 to 81, n = 9). Subjects received 1 gram of cephradine by a 5-minute intravenous (IV) infusion followed the next day by a 1-gram oral dose. Serial serum and urine samples collected over a period of 12 hours after the dose were analyzed for cephradine concentration by a microbiologic assay. After IV administration, mean serum cephradine concentrations in the elderly group were significantly higher at both 6 hours (1.52 +/- 0.41 mcg/mL) and 8 hours (0.73 +/- 0.22 mcg/mL) than in the young group at 6 hours (0.43 +/- 0.11 mcg/mL). Total systemic clearance was significantly lower (2.64 +/- 0.34 vs. 4.81 +/- 0.59 ml/min/kg) and the elimination half-life was significantly longer (1.71 +/- 0.20 vs 1.12 +/- 0.13 hours) in the elderly group (P = .0001). Systemic cephradine clearance correlated positively with creatinine clearance (r2 = 0.34, P = .0110) and negatively with age (r2 = 0.79, P = .0052). The mean volume of distribution was not significantly different between the two groups. Mean renal clearance was significantly lower in the elderly group (P = .0001), but more than 80% of the dose was excreted in the urine within 6 hours in both groups. After oral administration, the mean peak concentration and time to peak concentration did not differ between groups. The relative oral bioavailability was approximately 94% in both groups. The mean serum concentrations in the elderly were higher at both 6 and 8 hours than in the young group at 6 hours. There were no differences in pharmacokinetic parameters between male and female subjects. Because of reduced cephradine clearance secondary to an age-related decline in renal function, administration of cephradine every 8 hours, rather than every 6 hours, may be sufficient in elderly patients.