Comparação da eficácia clínica da associação amoxicilina e ácido clavulânico com oxacilina e ceftriaxone para tratamento hospitalar de pneumonia comunitária grave em crianças: estudo clínico randomizado
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Data
2010-07-05
Autores
Ribeiro, Cristiane Franco [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
As infecções respiratórias agudas (IRAs) são responsáveis por alta morbidade e mortalidade na faixa etária pediátrica, principalmente em crianças abaixo de cinco anos de idade, sendo a pneumonia adquirida na comunidade (PAC) a causa mais grave de IRA. A cada ano, dois a três milhões de crianças morrem de pneumonia, predominantemente nos países em desenvolvimento que é atribuída ao quadro clínico mais grave, ao envolvimento de bactérias como agentes etiológicos e ao menor acesso aos serviços de saúde e a terapia adequada. O estudo teve como objetivos comparar a resposta clínica ao tratamento empírico inicial Oxacilina associada à Ceftriaxone com Amoxicilina associada a Ácido Clavulânico em crianças de dois meses a cinco anos de idade com diagnóstico de Pneumonia Adquirida na Comunidade classificada como grave, que necessitem de internação hospitalar, bem como, avaliar o tempo de melhora clínica (febre e taquipnéia) e a necessidade de ampliação de espectro antimicrobiano para determinar falha terapêutica dos esquemas propostos. Trata-se de estudo clínico prospectivo randomizado realizado em pacientes com diagnóstico de PAC que necessitaram de internação na Enfermaria de Pediatria do Hospital das Clinicas da Faculdade de Medicina de Botucatu-UNESP. Foram incluídas 104 crianças de 2 meses a 5 anos de idade, no período de abril 2005 a maio 2008. Os pacientes foram sistematicamente divididos aleatoriamente, à sorte, para comporem dois grupos: grupo Oxacilina associada à Ceftriaxone (GOC; n=48) e grupo Amoxicilina associada ao Ácido Clavulânico (GAA; n=56). Os desfechos analisados foram: tempo de melhora clínica (taquipnéia e febre); tempo de suporte de oxigenioterapia (cateter nasal ou máscara de O2); tempo de internação na Enfermaria; necessidade de mudança da antibioticoterapia inicial e evolução para derrame pleural/empiema. Os grupos estudados...
Acute respiratory infections (ARIs) are responsible for high morbidity and mortality in pediatric patients, particularly in children less than five years old. Community-acquired pneumonia (CAP) is the most serious cause of ARI. Each year, from two to three million children die of pneumonia, predominantly in developing countries, and this is attributed to more severe clinical conditions, the involvement of bacteria as etiological agents, and less access to health care services and adequate therapy. This study aimed to compare clinical response to initial empirical treatment of Oxacillin associated with Ceftriaxone to Amoxicillin associated with Clavulanic Acid in children aged from two months to five years, diagnosed with severe community-acquired Pneumonia, who require hospitalization. It also aimed to evaluate the time for clinical recovery (fever and tachypnea) and the need for extending the antimicrobial spectrum in order to determine therapeutic failure in the proposed schemes. It is a prospective randomized study on patients diagnosed with CAP who required hospitalization in the Pediatric Ward of the Botucatu School of Medicine University Hospital-UNESP. One hundred and four children aged from 2 months to 5 years were included from April 2005 to May 2008. The patients were systematically divided randomly, by chance, in order to compose two groups: Oxacillin associated with Ceftriaxone group (OCG; n=48) and Amoxicillin associated with Clavulanic Acid group (AAG; n=56). The outcomes analyzed were: time of clinical recovery (tachypnea and fever); time of oxygen therapy support (nasal catheter or O2 mask); time of hospitalization in the ward; need for change in the initial antibiotic therapy and development to pleural effusion/empyema. The studied groups were not statistically different relating to age, gender or duration of symptoms prior to hospitalization. Comorbidities were ... (Complete abstract click electronic access below)
Acute respiratory infections (ARIs) are responsible for high morbidity and mortality in pediatric patients, particularly in children less than five years old. Community-acquired pneumonia (CAP) is the most serious cause of ARI. Each year, from two to three million children die of pneumonia, predominantly in developing countries, and this is attributed to more severe clinical conditions, the involvement of bacteria as etiological agents, and less access to health care services and adequate therapy. This study aimed to compare clinical response to initial empirical treatment of Oxacillin associated with Ceftriaxone to Amoxicillin associated with Clavulanic Acid in children aged from two months to five years, diagnosed with severe community-acquired Pneumonia, who require hospitalization. It also aimed to evaluate the time for clinical recovery (fever and tachypnea) and the need for extending the antimicrobial spectrum in order to determine therapeutic failure in the proposed schemes. It is a prospective randomized study on patients diagnosed with CAP who required hospitalization in the Pediatric Ward of the Botucatu School of Medicine University Hospital-UNESP. One hundred and four children aged from 2 months to 5 years were included from April 2005 to May 2008. The patients were systematically divided randomly, by chance, in order to compose two groups: Oxacillin associated with Ceftriaxone group (OCG; n=48) and Amoxicillin associated with Clavulanic Acid group (AAG; n=56). The outcomes analyzed were: time of clinical recovery (tachypnea and fever); time of oxygen therapy support (nasal catheter or O2 mask); time of hospitalization in the ward; need for change in the initial antibiotic therapy and development to pleural effusion/empyema. The studied groups were not statistically different relating to age, gender or duration of symptoms prior to hospitalization. Comorbidities were ... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Pneumonia em crianças - Tratamento - Teses, Antibioticos
Como citar
RIBEIRO, Cristiane Franco. Comparação da eficácia clínica da associação amoxicilina e ácido clavulânico com oxacilina e ceftriaxone para tratamento hospitalar de pneumonia comunitária grave em crianças: estudo clínico randomizado. 2010. 81 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2010.