Navegando por Palavras-chave "Antibiotic"

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    Como evitar o uso inadequado de antibióticos nas infecções de vias aéreas superiores? Posição de um painel de especialistas
    (Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2018) Piltcher, Otavio Bejzman; Kosugi, Eduardo Macoto [UNIFESP]; Sakano, Eulalia; Mion, Olavo; Testa, Jose Ricardo Gurgel [UNIFESP]; Romano, Fabrizio Ricci; Santos, Marco Cesar Jorge; Di Francesco, Renata Cantisani; Mitre, Edson Ibrahim; Bezerra, Thiago Freire Pinto; Roithmann, Renato; Padua, Francini Greco; Valera, Fabiana Cardoso Pereira; Lubianca Neto, Jose Faibes; Sa, Leonardo Conrado Barbosa; Pignatari, Shirley Shizue Nagata [UNIFESP]; Avelino, Melissa Ameloti Gomes; Caixeta, Juliana Alves de Souza; Anselmo-Lima, Wilma Terezinha; Tamashiro, Edwin
    Introduction: Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. Objectives: To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. Methods: A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. Results: Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into 'consideration'. Conclusions: Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use. (C) 2018 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license.
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    THE DE-ESCALATION CONCEPT and ANTIBIOTIC DE-ESCALATION: A MISSED OPPORTUNITY?
    (Lippincott Williams & Wilkins, 2013-05-01) Camargo, Luis Fernando Aranha [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hosp Israelita Albert Einstein
    De-escalation therapy is a term that suggests the need to reduce the spectrum or the number of antibiotics formerly prescribed for critical patients, upon clinical improvement and/or microorganism recovery. the major goal of this concept is the use of broad-spectrum antibiotic agents as initial drugs of choice for severe patients, instead of reserving the most potent agents after an inadequate clinical response, or after the microorganism is recovered. Despite possible commercial concerns and an unproven but possible relationship with enhancing global antibiotic use, the concept was correct and in accordance with scientific evidence. However, the de-escalation component of the concept is very seldom reported, and no large clinical trial on this issue is available until today. To definitely put in practice this concept, comparative large trials must be designed and sponsored to insert this strategy at the same level of evidence of wide initial empiric antibiotic treatments.
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    Identification of temporal clusters and risk factors of bacteremia by nosocomial vancomycin-resistant enterococci
    (Elsevier B.V., 2014-04-01) Silva, Natal Santos da; Muniz, Vitor Dantas; Estofolete, Cassia Fernanda; Campos Furtado, Guilherme Henrique [UNIFESP]; Rubio, Fernando Gongora; Med Coll Sao Jose do Rio Preto; Union Coll Great Lakes; Hosp Base; Universidade Federal de São Paulo (UNIFESP)
    Background: This study aimed to evaluate a different methodology for addressing the evolution of nosocomial bacteremia by vancomycin-resistant enterococci (VRE) in a hospital setting.Methods: in this retrospective cohort study, data were collected from the date of first registration up to December 2008 from the electronic medical records of patients with VRE bacteremia in a school hospital.Results: Thirty cases of VRE bacteremia and 274 cases of vancomycin-susceptible enterococci (VSE) bacteremia were identified. the average age of the patients was 56 years. the rates of Enterococcus faecium and Enterococcus faecalis in the hospital's intensive care unit (ICU) and wards showed no statistically significant differences. the risk of acquiring VRE bacteremia was at least 3-fold higher in the ICU than in the wards. the risk of death was 2.73-fold higher in patients with VRE bacteremia compared with those with VSE bacteremia. Only one temporal cluster statistically significant of VRE bacteremia was found in the study period.Conclusions: the identification of temporal clusters can be an important tool to optimize health actions and thereby reduce the burden of operating costs. Copyright (C) 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.