Gutiérrez-Castrellón P, Mayorga-Buitron JL, Bosch-Canto V, Solomon-Santibañez G, de Colsa-Ranero A

Idioma: Ingles.
Referencias bibliográficas: 69
Paginas: 126-135
Archivo PDF: 310.40 Kb.

RESUMEN

Justificación. Las infecciones respiratorias (IRAs) son uno de los procesos infecciosos más frecuentes en niños. Los macrolidos se han considerado como una de las mejores opciones para su tratamiento. La claritromicina es el macrolido más utilizado. No se ha publicado ningún metaanálisis sobre la eficacia y seguridad de la claritromicina en niños. Material y métodos. Se realizó una revisión sistematizada de la evidencia con metaanálisis de ensayos clínicos controlados (RCTs), efectuados en sujetos de ≤ 12 años con IRAs. Se efectuó búsqueda de la evidencia publicada en Central Cochrane Registry, MEDLINE, EMBASE, Lilacs y Artemisa de 1966 a enero 2011. Se analizaron como variables de desenlace la curación clínica, tasa de éxito, erradicación bacteriológica, riesgo de recaída y presencia de eventos adversos. Se efectuó cálculo de razón de riesgos (RR) con intervalo de confianza a 95% (IC95%), utilizando un modelo de efectos fijos. Resultados. Se incluyeron 24 estudios de un total de 76 RCTs evaluados. La claritromicina fue equivalente a otros antibióticos en relación con la curación clínica [RR 1.02 (0.98 a 1.06), p NS], tasa de éxito [RR 1.01 (0.99 a 1.03), p NS] y riesgo de recaída [RR 1.34 (0.81 a 2.21), p NS], asociándose con una mayor erradicación bacteriológica [RR 1.06 (1.02 a 1.09), p 0.001], y con un riesgo menor de eventos adversos relacionados [RR 0.77 (0.65 a 0.90), p = 0.001]. Conclusiones. La evidencia de calidad demuestra que la claritromicina es una alternativa eficaz y segura para el tratamiento de las IRAs en niños. Es superior a otros antibióticos en relación con la erradicación bacteriana. Su perfil de equivalencia con otros antibióticos para la curación clínica, tasa de éxito y riesgo de recaída la soportan como una alternativa significativa.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Snow V, Mottur-Pilson C, Coope RJ, Hoffman JR. Principles of appropriate antibiotic use for acute pharyngitis in adults. Ann Intern Med 2001; 134: 506-8.

2. Poses RM, Cebul RD, Collins M, Fager SS. The accuracy of experienced physicians’ probability estimates for patients with sore throats: implications for decision making. JAMA 1985; 254: 925-9.

3. Komaroff AL, Pass TM, Aronson MD, Erwin CT, Cretin S, Winickoff RN, Branch Jr. WT. The prediction of streptococcal pharyngitis in adults. J Gen Intern Med 1986; 1: 1-7.

4. Dowell SF, Schwartz B, Phillips WR. Appropriate use of antibiotics for URIs in children: Part II. Cough, pharyngitis, and the common cold. Am Fam Physician 1998; 58: 1335- 42, 45.

5. Bisno AL, Gerber MA, Gwaltney Jr. JM, Kaplan EL, Schwartz RH. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Clin Infect Dis 2002; 35: 113-25.

6. Randolph MF, Gerber MA, DeMeo KK, Wright L. Effect of antibiotic therapy on the clinical course of streptococcal pharyngitis. J Pediatr 1985; 106: 870-5.

7. Krober MS, Bass JW, Michels GN. Streptococcal pharyngitis: placebo-controlled double-blind evaluation of clinical response to penicillin therapy. JAMA 1985; 253: 1271-4.

8. Catanzero FJ, Stetson CA, Morris AJ. The role of streptococcus in the pathogenesis of rheumatic fever. Am J Med 1954; 17: 749-56.

9. Rammelkamp CH. Rheumatic heart disease-a challenge. Circulation 1958; 17: 842-51.

10. Committee on Infectious Diseases. Group A streptococcal infection. In: Pickering LK (ed.). Red Book. Elk Grove Village, IL.; 2001, p. 526-36.

11. McCarty J, Hedrick JA, Gooch WM. Clarithromycin suspension versus penicillin V suspension in children with streptococcal pharyngitis. Adv Ther 2000; 17: 14-26.

12. O’Doherty B. Azithromycin versus penicillin V in the treatment of paediatric patients with acute streptococcal pharyngitis/ tonsillitis. Paediatric Azithromycin Study Group. Eur J Clin Micro Infect Dis 1996; 15: 718-24.

13. Mehr, S, van Moerkerke M, Welck J, Sverrisson G, Sirotiakova J, Marr C, et al. Short course therapy with cefuroxime axetil for group A streptococcal tonsillopharyngitis in children. Pediatr Infect Dis J 1998; 17: 452-7.

14. Boccazzi A, Tonelli P, DeAngelis M, Bellussi L, Passali D, Careddu P. Short course therapy with ceftibuten versus azithromycin in pediatric streptococcal pharyngitis. Pediatr Infect Dis J 2000; 19: 963-7.

15. Adam D, Hostalek U, Troster K. 5-day therapy of bacterial pharyngitis and tonsillitis with cefixime: comparison with 10- day treatment with penicillin V. Cefixime Study Group [in German]. Klin Padiatr 1996; 208: 310-13.

16. Pichichero ME, Gooch WM, Rodriguez W, Blumer JL, Aronoff SC, Jacobs RF, et al. Effective short-course treatment of acute group A beta-hemolytic streptococcal tonsillopharyngitis: ten days of penicillin V vs. 5 days or 10 days of cefpodoxime therapy in children. Arch Pediatr Adolesc Med 1994; 148: 1053-60.

17. Tack KJ, Henry DC, Gooch WM, Brink DN, Keyserling CH. Five-day cefdinir treatment for streptococcal pharyngitis. Cefdinir Pharyngitis Study Group. Antimicrob Agents Chemother 1998; 42: 1073-5.

18. Lorenz J. Comparison of 5-day and 10-day cefixime in the treatment of acute exacerbation of chronic bronchitis. Chemotherapy 1998; 44(Suppl. 1): 15-18.

19. Reyes H, Guiscafre H, Munoz O, Perez-Cuevas R, Martinez H, Gutierrez G. Antibiotic noncompliance and waste in upper respiratory tract infections and acute diarrhea. J Clin Epidemiol 1997; 50: 1297-1304.

20. Daly KA, Brown JE, Lindgren BR, Meland MH, Le CT, Giebink GS. Epidemiology of otitis media onset by six months of age. Pediatrics 1999; 103(6, pt. 1): 1158-66.

21. McCaig LF, Besser RE, Hughes JM. Trends in antimicrobial prescribing rates for children and adolescents. JAMA 2002; 287(23): 3096-102.

22. Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis 1989; 160(1): 83-94.

23. Soni A. Ear infections (otitis media) in children (0-17): use and expenditures, 2006. Statistical Brief No. 228. Agency for Healthcare Research and Quality Web site. December 2008. Available from: http://www.meps.ahrq.gov/mepsweb/ data_files/publications/st228/stat228.pdf [Accessed September 20, 2010].

24. Simel DL, Rothman R, Keitz S. Update: otitis media, child. In: Simel DL, Rennie D [eds.]. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. New York, NY: McGraw- Hill; 2009. Available from: http//www jamaevidence.com/content/ 3484986 [Accessed September 2, 2010].

25. Spurling GK, Del Mar CB, Dooley L, Foxlee R. Delayed antibiotics for respiratory infections. Cochrane Database Syst Rev 2007; (3): CD004417.

26. Kozyrskyj AL, Hildes-Ripstein GE, Longstaffe SE, et al. Short course antibiotics for acute otitis media. Cochrane Database Syst Rev 2000; (2): CD001095.

27. Kozyrskyj AL, Hildes-Ripstein GE, Longstaffe SE, et al. Treatment of acute otitis media with a shortened course of antibiotics: a meta-analysis. JAMA 1998; 279(21): 1736-42.

28. Rosenfeld RM, Vertrees JE, Carr J, et al. Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr 1994; 124(3): 355-67.

29. Glasziou PP, Del Mar CB, Sanders SL, Hayem M. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 2004; (1): CD000219.

30. Takata GS, Chan LS, Shekelle PG, Morton SC, Mason W, Marcy SM. Evidence assessment of management of acute otitis media, I: the role of antibiotics in treatment of uncomplicated acute otitis media. Pediatrics 2001; 108(2): 239-47.

31. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics 2004; 113(5): 1451-65.

32. Coco A, Vernacchio L, Horst M, Anderson A. Management of acute otitis media after publication of the 2004 AAP and AAFP clinical practice guideline. Pediatrics 2010; 125(2): 214-20.

33. Casey JR, Adlowitz DG, Pichichero ME. New patterns in the otopathogens causing acute otitis media six to eight years after introduction of pneumococcal conjugate vaccine. Pediatr Infect Dis J 2010; 29(4): 304-09.

34. Rosenfeld RM, Kay D. Natural history of untreated otitis media. Laryngoscope 2003; 113(10): 1645-57.

35. Roblin PM, Montalban G, Hammerschlag MR. Susceptibilities to clarithromycin and erythromycin of isolates of Chlamydia pneumoniae from children with pneumonia. Antimicrob Agents Chemother 1994; 38: 1588-9.

36. Welsh L, Gaydos C, Quinn TC. In vitro activities of azithromycin, clarithromycin, erythromycin, and tetracycline against 13 strains of Chlamydia pneumoniae. Antimicrob Agents Chemother 1996; 40: 212-4.

37. Hardy RD, Rios AM, Chavez-Bueno S, Jafri HS, Hatfield J, Rogers BB, et al. Antimicrobial and immunologic activities of clarithromycin in a murine model of Mycoplasma pneumoniae-induced pneumonia. Antimicrob Agents Chemother 2003; 47: 1614-20.

38. Klein JO. Clarithromycin: where do we go from here? Pediatr Infect Dis J 1993; 12(12 Suppl. 3): S148-S151.

39. Hardy DJ, Swanson RN, Rode RA, Marsh K, Shipkowitz NL, Clement JJ. Enhancement of the in vitro and in vivo activities of clarithromycin against Haemophilus influenzae by 14- hydroxy-clarithromycin, its major metabolite in humans. Antimicrob Agents Chemother 1990; 34: 1407-13.

40. Neu HC. The development of macrolides: clarithromycin in perspective. J Antimicrob Chemother 1991; 27(Suppl. A): 1-9.

41. Chien SM, Pichotta P, Siepman N, Chan CK. Treatment of community-acquired pneumonia. A multicenter, double blind, randomized study comparing clarithromycin with erythromycin. Canada-Sweden Clarithromycin-Pneumonia Study Group. Chest 1993; 103: 697-701.

42. Block S, Hedrick J, Hammerschlag MR, Cassell GH, Craft JC. Mycoplasma pneumoniae and Chlamydia pneumoniae in pediatric community-acquired pneumonia: comparative efficacy and safety of clarithromycin vs. Erythromycin ethylsuccinate. Pediatr Infect Dis J 1995; 14: 471-7.

43. Still JG, Hubbard WC, Poole JM, Sheaffer CI, Chartrand S, Jacobs R. Comparison of clarithromycin and penicillin VK suspensions in the treatment of children with streptococcal pharyngitis and review of currently available alternative antibiotic therapies. Pediatr Infect Dis J 1993; 12(12 Suppl. 3): S134-S141.

44. Dickersin K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews. BMJ 1994; 309: 1286.

45. Lefebvre C, McDonald S. Development of a sensitive search strategy for reports of randomized controlled trials in EMBASE. Fourth International Cochrane Colloquium; 1996; Adelaide (Australia).

46. Still JG, Hubbard WC, Poole JM, Sheaffer CI, Chartrand S, Jacobs R. Comparison of clarithromycin and penicillin VK suspensions in the treatment of children with streptococcal pharyngitis and review of currently available alternative antibiotic therapies. Pediatric Infect Dis J 1993; 12(12 Suppl. 3): S134-S141.

47. Bedregal GP, Riedel KI, Casterán VJC, Berríos CX. Claritromicina versus penicilina en el tratamiento de las faringoamigdalitis por estreptococo beta hemolítico grupo A en niños. Rev Chil Infectol 1995; 12(2): 80-6.

48. Padilla-Raygoza N, Figueroa-Ferrari RC, Rivera-Sosa MR. Estudio comparativo del tratamiento de la faringitis streptococcica con claritromicina vs. amoxicilina-clavulanato. Rev Mex Pediatric 1995; 62: 13-5.

49. Padilla N, Figueroa R, Rivera R. Clarithromycin and amoxicillin clavulanate in the management of pharyngotonsyllitis. Poster presented at the third International Conference on Macrolides 1996; Jan Lisbon.

50. Castano E, Ortega C, Vallarino D, et al. Comparison of four antibiotics for the treatment of children with streptococcal pharyngitis. Poster presented at the third International Conference on Macrolides 1996; Jan Lisbon.

51. Kearsley NL, Campbell A, Sanderson AA, Weir RD, Kamdar MK, Coles SJ. Comparison of clarithromycin suspension and amoxycillin syrup for the treatment of children with pharyngitis and/or tonsillitis. Br J Clin Pract 1997; 51(3): 133-7.

52. Venuta A, Laudizi L, Beverelli A, Bettelli F, Milioli S, Garetti E. Azithromycin compared with clarithromycin for the treatment of streptococcal pharyngitis in children. J Int Med Res 1998; 26(3): 152-8.

53. McCarty J, Hedrick JA, Gooch WM. Clarithromycin suspension vs. penicillin V suspension in children with streptococcal pharyngitis. Adv Ther 2000; 17(1): 14-26.

54. Oliveros-Lozano F, Baltasar-López E. Eficacia clínica de la claritromicina comparada con la amoxicilina en infecciones respiratorias superiores en pacientes pediátricos. Rev Mex Puericultura y Pediatr 2001; 8: 150-9.

55. Syrogiannopoulos GA, Bozdogan B, Grivea IN, Ednie LM, et al.; The Hellenic Antibiotic-Resistant Respiratory Pathogens Study Group. Two dosages of clarithromycin for five days, amoxicillin/clavulanate for five days or penicillin V for ten days in acute group a streptococcal tonsillopharyngitis. Pediatr Infect Dis J 2004; 23: 857-65.

56. Padilla-Raygoza N, Moreno-Pacheco M. Comparación entre claritromicina, azitroicina y penicilina en el manejo de la faringitis estreptocócica en niños. Arch Inv Ped Mex 2005; 8: 5-11.

57. Coles SJ, Addlestone MB, Kamdar MK, Macklin JL. A comparative study of clarithromycin and amoxicillin suspensions in the treatment of pediatric patients with acute otitis media. Infection 1993; 21(4): 272-8.

58. Gooch WM 3rd, Gan VN, Corder WT, Khurana CM, Andrews WP Jr. Clarithromycin and cefaclor suspensions in the treatment of acute otitis media in children. Pediatr Infect Dis J 1993; 12(12 Suppl. 3): S128-S133.

59. Pukander JS, Jero JP, Kaprio EA, Sorri MJ. Clarithromycin vs. amoxicillin suspensions in the treatment of pediatric patients with acute otitis media. Pediatr Infect Dis J 1993; 12(12 Suppl. 3): S118-S121.

60. McCarty JM, Phillips A, Wiisanen R. Comparative safety and efficacy of clarithromycin and amoxicillin/clavulanate in the treatment of acute otitis media in children. Pediatr Infect Dis J 1993; 12(12 Suppl. 3): S122-S127.

61. Aspin MM, Hoberman A, McCarty J, McLinn SE, Aronoff S, Lang DJ, Arrieta A. Comparative study of the safety and efficacy of clarithromycin and amoxicillin-clavulanate in the treatment of acute otitis media in children. J Pediatr 1994; 125: 136-41.

62. Still JG, Hubbard WC, Poole JM, Sheaffer CI, Chartrand S, Jacobs R. Comparison of clarithromycin and penicillin VK suspensions in the treatment of children with streptococcal pharyngitis and review of currently available alternative antibiotic therapies. Pediatric Infect Dis J 1993; 12(12 Suppl. 3): S134-S141.

63. Ramet J. Belgian Pediatrician Clarithromycin Working Group. Comparative safety and efficacy of Clarithromycin and Azithromycin suspensions in the short course treatment of children with acute otitis media. Clan Drug Invest 1994; 9(2): 61-6.

64. Arguedas AG, Louisa C, Rodriguez F, et al. Azithromycin vs. Clarithromycin in children with bacteriologically documented acute otitis media with effusion. Presented at the 19th congress on chemotherapy 1995, July 16-22, Montreal.

65. Ramet J. Belgian Pediatrician Clarithromycin Working Group. A comparative saftey and efficacy study of clarithromycin vs. Amoxicillin/clavulanate suspension in the short course treatment of children with acute otitis media. Poster presented at the third International Conference on Macrolides 1996; Jan Lisbon.

66. Craft JC, Siemen N, Palmer RN, et al. Treatment of acute otitis media in children comparing clarithromycin vs. amoxicillin/ clavulanate. Poster presented at the third International Conference on Macrolides 1996; Jan Lisbon.

67. Kafetziz DA, Bairamis T, Apostolopulus N. Five days treatment of children with acute otitis media with clarithromycin. Poster presented at the third International Conference on Macrolides 1996; Jan Lisbon.

68. Syriopoulu V, Pavlopoulu J, Theodoridou M, et al. Clarithromycin vs. cefaclor suspension in the treatment of acute otitis media in children. Poster presented at the third International Conference on Macrolides 1996; Jan Lisbon.

69. Gooch WM 3rd, Adelglass J, Kelsey DK, Masica D, Johns D Jr, Weinberg BC. Loracarbef versus clarithromycin in children with acute otitis media with effusion. Clin Ther 1999; 21(4): 711-22.