Resistencias bacterianas y farmacodinámica como bases de la prescripción de antibióticos en infecciones respiratorias

Aguado-García, José María; Martín-Herrero, José Emilio; Lumbreras, Carlos

doi:10.1157/13059054

Cited by 8 publications

(3 citation statements)

References 59 publications

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“…In a multicenter, prospective observational study in children with severe CAP due to S. pneumoniae, the use of 200,000 IU/kg/day of aqueous penicillin G in 4 daily doses was proposed and good effectiveness of this posologic regimen was demonstrated (19). The rationale for the use of 200,000 IU/kg/day of aqueous penicillin G was to overcome penicillin resistance in pneumococcal CAP by increasing the dose and, therefore, increasing the duration of the serum concentration of penicillin above the MIC (10,20). The administration in 4 daily doses was based on a more comfortable posologic regimen, with lower administration costs, better use of a Numerators indicate the number of children with the finding and denominators indicate the total number of children examined for the finding.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of the Efficacies of Two Different Regimens of Aqueous Penicillin G Administered to Children with Pneumonia

Brandão

Simbalista

Borges

et al. 2014

Antimicrob Agents Chemother

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dCommunity-acquired pneumonia (CAP) is an important childhood health problem. Penicillin remains appropriate for treating children with CAP. Clinical data are lacking on disease evolution in children treated with different posologic schemes of aqueous penicillin G. To assess if there were differences in disease evolution between children with CAP treated with 6 or 4 daily doses of aqueous penicillin G, we reviewed the medical charts of hospitalized patients 2 months to 11.5 years of age. Pneumonia was radiologically confirmed based on the detection of pulmonary infiltrate or pleural effusion on the chest radiograph taken on admission and read by a pediatric radiologist blinded to the clinical data. The total daily dose of aqueous penicillin G was 200,000 IU/kg of body weight. Data were recorded on admission, during disease evolution up to the 7th day of treatment, and at the final outcome. The results of hospitalization and the daily frequency of physical signs suggestive of pneumonia were assessed. The subgroups comprised 120 and 144 children who received aqueous penicillin G in 6 or 4 daily doses, respectively. Children >5 years of age were more frequent in the 4-daily-doses subgroup (16.0% versus 4.2%; respectively, P ‫؍‬ 0.02). There were no differences between the compared subgroups in terms of final outcomes, lengths of hospitalization, durations of aqueous penicillin G use, frequencies of aqueous penicillin G substitution, or daily frequencies of tachypnea, fever, chest retraction, lower chest recession, nasal flaring, and cyanosis up to the 7th day of treatment. The studied posologic regimens were similarly effective in treating children hospitalized with a radiologically confirmed CAP diagnosis. Aqueous penicillin G (200,000 IU/kg/day) may be given in 4 daily doses to children with CAP. C ommunity-acquired pneumonia (CAP) is an important childhood health problem that accounts for approximately 1.396 million child deaths (1) and 154 million cases (2, 3) annually among children under 5 years old around the world. In clinical practice, it is not routinely possible to identify the etiological agent of the disease (4). Based on a wide range of evidence, Streptococcus pneumoniae is recognized as the most common bacterial agent of CAP (5). This is the rationale behind choosing antibiotics that target this pathogen (4). That is why penicillin and its derivatives remain the appropriate antimicrobial agents to treat children with CAP (6). When hospitalization is required, the first-line drug is intravenous aqueous penicillin G (7).In the 1990s, pneumococcal resistance to penicillin had been widely recognized as a potential problem but the increased dose of penicillin was shown to be effective in overcoming this problem as long as the infection did not affect the central nervous system (8). This finding may be explained by the time-dependent killing characteristic of penicillin (9). That is, the period of time during which the level of penicillin in serum is higher than the MIC is predictive of the therapeutic eff...

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Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of the Efficacies of Two Different Regimens of Aqueous Penicillin G Administered to Children with Pneumonia

Brandão

Simbalista

Borges

et al. 2014

Antimicrob Agents Chemother

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“…Si bien la concentración sérica de levofloxacino (C max ) es superior a la de moxifloxacino, para obtener un valor del área bajo la curva similar a la de éste, levofloxacino debería administrarse a dosis de 500 mg/12 h [14,60]. El tiempo de exposición durante las 24 h del día o área bajo la curva inhibitoria conseguida (ABC 24 /CMI), es trascendental para estimar la eficacia clínica, ya que, cuanto mayor sea ésta (para S. pneumoniae debe ser siempre ≥ 30 mg/h/l), aumentará el éxito clínico y disminuirá la posibilidad de desarrollo de mutantes y aparición de resistencias, hecho crucial que ocurre con moxifloxacino vía oral (según las CMIs su ABC 24 /CMI se sitúa entre 96-384 mg/h/l), mientras que para levofloxacino o azitromicina (por vía oral) son de 35 y 3 mg/h/l, respectivamente [14,60-62]. …”

Section: Tratamientounclassified

“…Dentro de este grupo y frente a S. pneumoniae, cefditoreno es varias veces más activo que amoxicilina-clavulánico, aunque en la práctica los parámetros FC-FD (farmacocinética/farmacodinámica) de ambos son superponibles con dosis de 400 mg/12 h de cefditoreno y dosis de 2.000/125 mg/12 h de la formulación retardada de amoxicilina-clavulánico durante 10 días para una NAC. Así según sus CMIs, la actividad in vitro previsible de cefditoreno es de 94% con dosis de 200 mg/12 h y de 99,8% a dosis de 400 mg/12 h, lo que le convierte con esta última pauta en la mejor opción entre las cefalosporinas vía oral [14,60,62,63]. …”

Section: Tratamientounclassified

Características y cambios epidemiológicos de los pacientes con neumonía adquirida en la comunidad en los servicios de urgencias hospitalarios

Julián-Jiménez¹,

Castillo

Zárate

et al. 2013

Anales Sis San Navarra

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Fundamento. El objetivo de este artículo es determinar la prevalencia y conocer los cambios epidemiológicos más relevantes en la última década en la neumonía adquirida en la comunidad (NAC) en los servicios de urgencias (SU), así como el perfil y manejo de los pacientes. Métodos. Estudio descriptivo con análisis transversal, multicéntrico en 49 SU españoles durante 12 meses. Se incluyeron todos los pacientes con el diagnóstico de NAC, de infección respiratoria y de infección. Se registraron todos los pacientes atendidos en los SU. resultados. La prevalencia de la NAC ha aumentado entre los pacientes en el SU en la última década del 0,85% al 1,35% (p<0,001). El 51% de las NAC se registraron en pacientes con 70 o más años. El 69,8 % tenían alguna enfermedad de base y el 17,8% alguno de los factores de riesgo para desarrollar infección. El 11,7% cumplían criterios de sepsis, 4,6% de sepsis grave y el 3% shock séptico. El 37% de los pacientes recibieron el alta desde el SU. conclusiones. El impacto y prevalencia de la NAC en los SU ha aumentado en la última década. Es la causa más frecuente de sepsis, sepsis grave y shock séptico, de ingreso en la unidad de cuidados intensivos y de fallecimiento por enfermedad infecciosa. Palabras clave. Neumonía adquirida en la comunidad. Epidemiología. Servicios de Urgencias. Infección respiratoria. abstract background.

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Tratamiento empírico de las infecciones en el adulto

2007

FMC - Formación Médica Continuada en Atención Primaria

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Resistencias bacterianas y farmacodinámica como bases de la prescripción de antibióticos en infecciones respiratorias

Cited by 8 publications

References 59 publications

Retrospective Analysis of the Efficacies of Two Different Regimens of Aqueous Penicillin G Administered to Children with Pneumonia

Retrospective Analysis of the Efficacies of Two Different Regimens of Aqueous Penicillin G Administered to Children with Pneumonia

Características y cambios epidemiológicos de los pacientes con neumonía adquirida en la comunidad en los servicios de urgencias hospitalarios

Tratamiento empírico de las infecciones en el adulto

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