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- ItemAcesso aberto (Open Access)Aqueous humor concentrations of topical fluoroquinolones alone or in combination with a steroid(Consel Brasil Oftalmologia, 2017) Rodrigues Gomes, Rachel Lopes [UNIFESP]; Viana, Rodrigo Galvao; Soares Melo, Luiz Alberto, Jr. [UNIFESP]; Cruz, Alessandro Carvalho [UNIFESP]; de Souza Lima Filho, Acacio Alves [UNIFESP]; Suenaga, Eunice Mayumi [UNIFESP]; Campos, Mauro [UNIFESP]Purpose: To compare the aqueous humor (AH) concentrations of moxifloxacin 0.5% and gatifloxacin 0.3% solutions alone or when treatment was combined with steroids, and to correlate these concentrations with the minimum inhibitory concentrations (MIC) for the most common endophthalmitis-causing organisms. Methods: Patients undergoing phacoemulsification were enrolled to receive one drop of one of the following solutions: moxifloxacin (G1), moxifloxacin + dexamethasone (G2), gatifloxacin (G3), or gatifloxacin + c (G4), every 15 min, 1h before surgery. AH samples were collected before surgery and analyzed using HPLC-tandem mass spectrometry. Results: The mean antibiotic concentrations in the AH were: G1= 1280.8 ng/mL, G2= 1644.3 ng/mL, G3= 433.7 ng/mL and G4= 308.1 ng/mL. The mean concentrations statistically differed between G1 and G2 (p=0.01), and G3 and G4 (p=0.008). All samples achieved the MIC for Staphylococcus epidermidis 100% of the samples from G1 and G2, and 97% from G3 and G4 reached the MIC for fluoroquinolone-sensitive Staphylococcus aureus 100% of the samples from G1 and G2, 88% from G3, and 72% from G4 reached the MIC for enterococci (p<0.001) and 100% of samples from G1 and G2, 59% from G3, and 36% from G4 reached the MIC for Streptococcus pneumoniae (p<0.001). For fluoroquinolone-resistant S. aureus, 23% from G1, 44% from G2, and no samples from G3 or G4 achieved the MIC (p<0.001). Conclusions: Moxifloxacin + dexamethasone demonstrated a higher concentration in the AH than the moxifloxacin alone. Gatifloxacin + steroids demonstrated less penetration into the anterior chamber than gatifloxacin alone. Moxifloxacin was superior to gatifloxacin considering the MIC for enterococci, S. pneumoniae, and fluoroquinolone-resistant S. aureus.
- ItemAcesso aberto (Open Access)Concentração de fluorquinolonas no humor aquoso após instilação tópica de soluções comerciais com ou sem corticosteroides(Universidade Federal de São Paulo (UNIFESP), 2017-09-28) Gomes, Rachel Lopes Rodrigues [UNIFESP]; Campos, Mauro Silveira de Queiroz [UNIFESP]; http://lattes.cnpq.br/8668472375424523; http://lattes.cnpq.br/8893745851398408; Universidade Federal de São Paulo (UNIFESP)Objetivos: comparar a concentração de moxifloxacino ou gatifloxacino no humor aquoso após o uso tópico do moxifloxacino 0.5% ou gatifloxacino 0.3% isolados ou combinados com corticosteroides, e correlacionar a concentração com a concentração inibitória mínima (MIC) para os agentes microbianos mais comumente relacionados à endoftalmites. Métodos: pacientes com indicação de cirurgia de catarata foram selecionados para receber um dos seguintes regimes profiláticos: 1 gota de 6/6h, 1 dia antes da cirurgia (grupos 1 e 2) e 1 gota, 1 hora antes da cirurgia ou 1 gota a cada 15 min, 1 hora antes do procedimento (grupos 3 a 6). Uma das seguintes soluções: moxifloxacino (grupos 2 e 3), moxifloxacino+dexametasona (grupos 1 e 4), gatifloxacino (grupo 5) ou gatifloxacino+prednisolona (grupo 6). Amostras do humor aquoso foram coletadas antes do início da cirurgia. As concentrações do antibiótico nas amostras foram determinadas por meio de cromatografia líquida de alta eficiência acoplada a espectrômetro de massas (LC-MS/MS). Resultados: as concentrações médias de antibiótico nas amostras foram: grupo 1=986.6 ng/mL; grupo 2= 741.3 ng/mL; grupo 3=1280.8 ng/ml; grupo 4=1644.3 ng/ml; grupo 5=433.7 ng/ml; grupo 6=308.1 ng/ml. Entre os grupos 1 e 2 a diferença entre as médias não foi estatisticamente significativa (p=0.13). Por sua vez, entre os grupos 3 e 4 (P=0.01) e entre os grupos 5 e 6 (P=0.008) a diferença foi significativa. Todas as amostras alcançaram MIC para S. epidermidis; 100% das amostras dos grupos 1, 2, 3 e 4, e 97% dos grupos 5 e 6 atingiram o MIC para S. aureus fluoroquinolona-sensível; 100% das amostras dos grupos 1, 3 e 4, 94% do grupo 2, 88% do grupo 5 e 72% do grupo 6 atingiram o MIC para Enterococci (P<0.001); e 100% das amostras dos grupos 1, 2, 3 e 4, 59% do grupo 5 e 36% do grupo 6 atingiram o MIC para S. pneumoniae (P<0.001). Para o S. aureus resistente a fluoroquinolona, 29% do grupo 1, 9% do grupo 2, 23% do grupo 3, 44% do G4, e nenhuma das amostras grupos 5 e 6 atingiram o MIC (P<0.001). Conclusão: moxifloxacino associado à dexametasona demonstrou maior concentração no humor aquoso quando comparada com o moxifloxacino sem associação com corticoide. Gatifloxacino associado à prednisolona demonstrou menor penetração na câmara anterior quando comparado com o a penetração do gatfloxacino isolado. Maior número de amostras do grupo do moxifloxacino atingiu o MIC para Enterocci, S. pneumomiae e S. aureus resistente a fluorquinolonas.
- ItemEmbargoEfetividade e segurança do descalonamento de antimicrobianos em pacientes com sepse, sepse grave ou choque séptico: revisão sistemática(Universidade Federal de São Paulo (UNIFESP), 2009-05-27) Silva, Brenda Nazaré Gomes da [UNIFESP]; Salomão, Reinaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Sepsis, severe sepsis and septic shock have been associated with high incidence and mortality rates through different regions at the world. Such characteristics force up care givers to empirically offer early broad spectrum antimicrobial therapy. However, this approach introduce a selective pressure in the pathogens, what causes an increasing resistance to the antimicrobial agents, besides of adverse events and costs. De-escalation of an broad spectrum and adequate antimicrobial therapy have been proposed as an therapeutic option to avoid the use of unnecessary antimicrobial agents and, thus minimize the selective pressure over the pathogens, adverse events and costs associated to antimicrobial therapies. Objective: To evaluate the effectiveness and safety of de-escalation of empirical and broad-spectrum antimicrobial therapies in adult patients diagnosed with sepsis, severe sepsis and septic shock, irrespective of the microorganism responsible for the infection. Methods: A systematic review of randomized or quasirandomized controlled trials, according to the Cochrane Anaesthesia Collaborative Review Group. A sensitive search strategy was run through four electronic databases Cochrane – CENTRAL, Lilacs, Pubmed e EMBASE), bibliographic references of relevant articles and electronic contact with the main authors in the theme. There was no restriction regards to the idiom and date of the publications. Results: No randomized ou quasi-randomized controlled trial which fulfilled inclusion criteria minimal to solve the question of this systematic review was found. De-escalation has been recommended or suggested for clinical practice based on Cohort studies, narrative reviews and specialist opinions about clinical conditions similar to sepsis, severe sepsis and septic shock, mainly ventilator associated pneumonia. Conclusions: According to the findings of this systematic review, there is no adequate or definitive evidence to either support or not the de-escalation for patients with sepsis, severe sepsis or septic shock.
- ItemAcesso aberto (Open Access)Evidence on acne therapy(Associacao Paulista Medicina, 2013-01-01) Costa, Caroline Sousa; Bagatin, Edileia [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Among the current treatments available for acne vulgaris, many widely practiced options lack support from studies at the best level of scientific evidence. the aim of this narrative review was to present the very latest information on topical and systemic treatments for acne vulgaris. Information from systematic reviews and well-designed clinical trials, obtained through a systematic search of the major medical databases, is emphasized. There are important issues regarding the clinical management of acne that still lack consistent grounding in scientific evidence. Among these are the optimum dose and duration of treatment with oral antibiotics that can be given without inducing bacterial resistance, and the safety of oral isotretinoin.
- ItemAcesso aberto (Open Access)Nephrotoxicity Of Polymyxin B: Experimental Study In Cells And Implications For Nursing Practice(Universidade de São Paulo, Escola de Enfermagem, 2014-04-01) Neiva, Luciana Barros de Moura; Borges, Fernanda Teixeira; Watanabe, Mirian; Pessoa, Edson de Andrade; Barbosa, Dulce Aparecida [UNIFESP]; Vattimo, Maria de Fatima Fernandes; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)The aim of the study was to characterize the cell damage mechanisms involved in the pathophysiology of cytotoxicity of polymyxin B in proximal tubular cells (LLC - PK1) and discuss about the nurses interventions to identify at risk patients and consider prevention or treatment of nephrotoxicity acute kidney injury. This is a quantitative experimental in vitro study, in which the cells were exposed to 375μM polymyxin B sulfate concentration. Cell viability was determined by exclusion of fluorescent dyes and morphological method with visualization of apoptotic bodies for fluorescence microscopy. Cells exposed to polymyxin B showed reduced viability, increased number of apoptotic cells and a higher concentration of the enzyme lactate dehydrogenase. The administration of polymyxin B in vitro showed the need for actions to minimize adverse effects such as nephrotoxicity.
- ItemAcesso aberto (Open Access)Safety and efficacy of intracameral moxifloxacin injection for prophylaxis of endophthalmitis after phacoemulsification(Consel Brasil Oftalmologia, 2017) Vieira, Ibraim Viana [UNIFESP]; Boianovsky, Celso; Saraiva, Thais Jones; de Godoy, Rodolfo Bregion; Lake, JonathanPurpose: To evaluate the safety and efficacy of 0.05 mL intracameral injection of moxifloxacin in patients who underwent phacoemulsification and intraocular lens (IOL) implant. Methods: Retrospective study comprising patients who underwent phacoemulsification and IOL implant between January 2009 and December 2013. Patients were divided into two groups. Group A followed standard endophthalmitis prevention protocol and group B followed the same protocol plus intracameral injection of 0.05 mL of moxifloxacin hydrochloride at 5.45 mg/mL, immediately after IOL implant. Results: Medical records from 7,195 eyes of 3,751 patients (median age: 67.8 +/- 8.96, range: 48-83 years, 53.8% female) were evaluated. Group A included 3,515 eyes of 1,838 patients and group B included 3,680 eyes of 1,913 patients. The incidence of endophthalmitis in group A was 0.22% (8: 3,515 eyes) and in group B was 0.03% (1: 3,680 eyes, p= 0.0198, Fischer's exact test). No toxicity or inflammation related to the use of moxifloxacin was observed. Conclusions: There was a 7.3-fold lower ratio of endophthalmitis in the group that received moxifloxacin intracameral injection. This study provides further evidence that moxifloxacin is an effective intracameral prophylactic antibiotic.
- ItemAcesso aberto (Open Access)Vancomycin serum concentrations in pediatric oncologic/hematologic intensive care patients(Brazilian Society of Infectious Diseases, 2012-08-01) Silva, Dáfne Cardoso Bourguignon da [UNIFESP]; Seixas, Gláucia Toribio Finoti [UNIFESP]; Araujo, Orlei Ribeiro de [UNIFESP]; Arduini, Rodrigo Genaro [UNIFESP]; Carlesse, Fabianne Altruda de Moraes Costa [UNIFESP]; Petrilli, Antonio Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: Usual treatment regimens with vancomycin often fail to provide adequate serum levels in patients with severe infections. METHODS: Retrospective analysis of vancomycin trough serum measurements. The following parameters were calculated by Bayesian analysis: vancomycin clearance, distribution volume, and peak estimated concentrations. The area under the concentration curve (AUC) (total daily dose/24 h clearance of vancomycin) was used to determine the effectiveness of treatment through the ratio of AUC/minimum inhibitory concentration (MIC) above 400, using MIC = 1 µg/mL, based on isolates of Staphylococci in cultures. RESULTS: Sixty-one vancomycin trough measurements were analyzed in 31 patients. AUC/MIC > 400 was obtained in 34 out of 61 dosages (55.7%), but the mean vancomycin dose required to achieve these levels was 81 mg/kg/day. In cases where the usual doses were administered (40-60 mg/kg/day), AUC/MIC > 400 was obtained in nine out of 18 dosages (50%), in 13 patients. Trough serum concentrations above 15 mg/L presented a positive predictive value of 100% and a negative predictive value of 71% for AUC/MIC > 400. CONCLUSION: Higher than usual vancomycin doses may be required to treat staphylococcal infections in children with oncologic/hematologic diseases. Since the best known predictor of efficacy is the AUC/MIC ratio, serum trough concentrations must be analyzed in conjunction with MICs of prevalent Staphylococci and pharmacokinetic tools such as Bayesian analysis.