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Antibioacuteticos
bull Safety y security bull En la atencioacuten de salud bioseguridad
bull Resistencia a muacuteltiplesAntimicrobianos
Antibioacuteticos
bull Atribuida a Hipoacutecrates rdquoPremium Non Nocererdquo
Antibioacuteticos
Uso racional de Antibioacuteticos en nintildeos
iquestEs posible el cambio temprano a Viacutea Oral
iquestCuaacutento debe durar un tratamiento antibioacutetico
Dra Tamara Viviani
Jefa Infectologiacutea Pediaacutetrica CARS
Profesor asociado PUC de Chile
Antibioacuteticos
bull Problema Resistencia
bull Actores Todos Especialista en enfermedades infecciosas
bull Caminos de solucioacuten Promover un uso racional de antibioacuteticos
Disminuir la exposicioacuten a antibioacuteticos
Guias de uso de antibioacuteticos
AntibioacuteticosOMS
bull La resistencia a los antibioacuteticos es hoy una de las mayores amenazas para la salud mundial la seguridad alimentaria y el desarrollo
bull La resistencia a los antibioacuteticos puede afectar a cualquier persona sea cual sea su edad o el paiacutes en el que viva
bull La resistencia a los antibioacuteticos es un fenoacutemeno natural aunque el uso indebido de estos faacutermacos en el ser humano y los animales estaacute acelerando el proceso
bull Cada vez es mayor el nuacutemero de infecciones mdashpor ejemplo neumoniacutea tuberculosis gonorrea y salmonelosismdash cuyo tratamiento se vuelve maacutes difiacutecil debido a la peacuterdida de eficacia de los antibioacuteticos
bull La resistencia a los antibioacuteticos prolonga las estancias hospitalarias incrementa los costos meacutedicos y aumenta la mortalidad
Antibioacuteticos
WAAAR (World Alliance Againt Antibiotic Resistance ) 2011
bull Representantes de todos los continentes
bull Poliacuteticas Puacuteblicas
bull WHO
bull WO animal Health
bull FAO
bull CDChelliphelliphellip
TODOS
Antibioacuteticos
Causas de la MR
bull ATB actuacutean a nivel de agente etioloacutegico y del microbioma estimulando en ambos la resistencia
bull Las bacterias resistentes del microbioma persisten largos periacuteodos y pueden tranferirse a otros pacientes a la comunidad y al ambiente
bull Relacioacuten estrecha entre uso de ATB y multiresistencia
bull Paises con menos consumo de ATB tienen menos problemas de multiresistencia
BMJ 2010 340c2096
Antibioacuteticos
Antibioacuteticos
Nintildeos
bull Farmacodinamia en poblacioacuten pediaacutetrica
bull Dosis en pediatriacutea
bull Falta de investigacioacuten un problema para tener dosis efectivas y seguras en pediatriacutea
bull Uso no autorizado para faacutermacos en pediatriacutea Off-label
bull No todos los antibioacuteticos en formulacioacuten pediaacutetrica
Off- label
bull Edad
bull Peso
bull Sin informacioacuten en nintildeos
bull Otra indicacioacuten
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Distribucioacuten
bull Contenido corporal de agua La fraccioacuten de agua corporal total es muy alta en el feto y se va reduciendo a partir del nacimiento en paralelo al aumento del porcentaje de grasa corporal
bull Concentracioacuten de proteiacutenas plasmaacuteticas La unioacuten a proteiacutenas se encuentra reducida en neonatos
bull Permeabilidad de las membranas maacutes permeables en RN y hasta los 12-14 antildeos
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Absorcioacuten oral de medicamentos
bull Cambios en el pH intraluminal gaacutestrico
bull Vaciamiento gaacutestrico maacutes lento
bull Cambios en la flora bacteriana del intestino
bull Cambios en la funcioacuten biliar
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
PARENTERAL
bull Costos antibioacuteticos ev son hasta 20 veces maacutes caros
bull 35 gastos en medicamentos en pacientes hospitalizados
bull Mitos maacutes seguros
ORAL
bull Adherencia 1-2 de cada 3 no finaliza tratamiento
bull Penicilina y St pyogenes 3 diacuteas 44 6 dia 29 9 dia 18
bull Miedo a recaiacuteda
bull Mitos que tratamientos cortos aumentan la resistencia (meacutedicos)
Rev Chil Infect 201633(2)177-186 Bernal-Vargas M
Antibioacuteticos
Switch a oral
bull La viacutea ideal de administracioacuten de cualquier antibioacutetico es aquella que alcance niveles plasmaacuteticos suficientes para el efecto deseado
bull Terapia secuencial mismo ATB (Ciprofloxacino EV ndash oral)
bull Terapia de cambio ATB EV ndash Oral no es igual pero la misma potencia (Ceftriaxone- Cefixime)
bull Terapia de reduccioacuten ATB EV ndash Oral no tiene la misma actividad (Cefotaxima-Ciprofloxacino)
J Pharmacol Pharmacothe2014Apr-Jun5(2) CyriacJM
AntibioacuteticosOral debe alcanzar niveles plasmaacuteticos similares a EV
ATB orales elegibles con 60-90 biodisponibilidad
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
Antibioacuteticos
J
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Uso racional de Antibioacuteticos en nintildeos
iquestEs posible el cambio temprano a Viacutea Oral
iquestCuaacutento debe durar un tratamiento antibioacutetico
Dra Tamara Viviani
Jefa Infectologiacutea Pediaacutetrica CARS
Profesor asociado PUC de Chile
Antibioacuteticos
bull Problema Resistencia
bull Actores Todos Especialista en enfermedades infecciosas
bull Caminos de solucioacuten Promover un uso racional de antibioacuteticos
Disminuir la exposicioacuten a antibioacuteticos
Guias de uso de antibioacuteticos
AntibioacuteticosOMS
bull La resistencia a los antibioacuteticos es hoy una de las mayores amenazas para la salud mundial la seguridad alimentaria y el desarrollo
bull La resistencia a los antibioacuteticos puede afectar a cualquier persona sea cual sea su edad o el paiacutes en el que viva
bull La resistencia a los antibioacuteticos es un fenoacutemeno natural aunque el uso indebido de estos faacutermacos en el ser humano y los animales estaacute acelerando el proceso
bull Cada vez es mayor el nuacutemero de infecciones mdashpor ejemplo neumoniacutea tuberculosis gonorrea y salmonelosismdash cuyo tratamiento se vuelve maacutes difiacutecil debido a la peacuterdida de eficacia de los antibioacuteticos
bull La resistencia a los antibioacuteticos prolonga las estancias hospitalarias incrementa los costos meacutedicos y aumenta la mortalidad
Antibioacuteticos
WAAAR (World Alliance Againt Antibiotic Resistance ) 2011
bull Representantes de todos los continentes
bull Poliacuteticas Puacuteblicas
bull WHO
bull WO animal Health
bull FAO
bull CDChelliphelliphellip
TODOS
Antibioacuteticos
Causas de la MR
bull ATB actuacutean a nivel de agente etioloacutegico y del microbioma estimulando en ambos la resistencia
bull Las bacterias resistentes del microbioma persisten largos periacuteodos y pueden tranferirse a otros pacientes a la comunidad y al ambiente
bull Relacioacuten estrecha entre uso de ATB y multiresistencia
bull Paises con menos consumo de ATB tienen menos problemas de multiresistencia
BMJ 2010 340c2096
Antibioacuteticos
Antibioacuteticos
Nintildeos
bull Farmacodinamia en poblacioacuten pediaacutetrica
bull Dosis en pediatriacutea
bull Falta de investigacioacuten un problema para tener dosis efectivas y seguras en pediatriacutea
bull Uso no autorizado para faacutermacos en pediatriacutea Off-label
bull No todos los antibioacuteticos en formulacioacuten pediaacutetrica
Off- label
bull Edad
bull Peso
bull Sin informacioacuten en nintildeos
bull Otra indicacioacuten
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Distribucioacuten
bull Contenido corporal de agua La fraccioacuten de agua corporal total es muy alta en el feto y se va reduciendo a partir del nacimiento en paralelo al aumento del porcentaje de grasa corporal
bull Concentracioacuten de proteiacutenas plasmaacuteticas La unioacuten a proteiacutenas se encuentra reducida en neonatos
bull Permeabilidad de las membranas maacutes permeables en RN y hasta los 12-14 antildeos
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Absorcioacuten oral de medicamentos
bull Cambios en el pH intraluminal gaacutestrico
bull Vaciamiento gaacutestrico maacutes lento
bull Cambios en la flora bacteriana del intestino
bull Cambios en la funcioacuten biliar
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
PARENTERAL
bull Costos antibioacuteticos ev son hasta 20 veces maacutes caros
bull 35 gastos en medicamentos en pacientes hospitalizados
bull Mitos maacutes seguros
ORAL
bull Adherencia 1-2 de cada 3 no finaliza tratamiento
bull Penicilina y St pyogenes 3 diacuteas 44 6 dia 29 9 dia 18
bull Miedo a recaiacuteda
bull Mitos que tratamientos cortos aumentan la resistencia (meacutedicos)
Rev Chil Infect 201633(2)177-186 Bernal-Vargas M
Antibioacuteticos
Switch a oral
bull La viacutea ideal de administracioacuten de cualquier antibioacutetico es aquella que alcance niveles plasmaacuteticos suficientes para el efecto deseado
bull Terapia secuencial mismo ATB (Ciprofloxacino EV ndash oral)
bull Terapia de cambio ATB EV ndash Oral no es igual pero la misma potencia (Ceftriaxone- Cefixime)
bull Terapia de reduccioacuten ATB EV ndash Oral no tiene la misma actividad (Cefotaxima-Ciprofloxacino)
J Pharmacol Pharmacothe2014Apr-Jun5(2) CyriacJM
AntibioacuteticosOral debe alcanzar niveles plasmaacuteticos similares a EV
ATB orales elegibles con 60-90 biodisponibilidad
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
Antibioacuteticos
J
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
bull Problema Resistencia
bull Actores Todos Especialista en enfermedades infecciosas
bull Caminos de solucioacuten Promover un uso racional de antibioacuteticos
Disminuir la exposicioacuten a antibioacuteticos
Guias de uso de antibioacuteticos
AntibioacuteticosOMS
bull La resistencia a los antibioacuteticos es hoy una de las mayores amenazas para la salud mundial la seguridad alimentaria y el desarrollo
bull La resistencia a los antibioacuteticos puede afectar a cualquier persona sea cual sea su edad o el paiacutes en el que viva
bull La resistencia a los antibioacuteticos es un fenoacutemeno natural aunque el uso indebido de estos faacutermacos en el ser humano y los animales estaacute acelerando el proceso
bull Cada vez es mayor el nuacutemero de infecciones mdashpor ejemplo neumoniacutea tuberculosis gonorrea y salmonelosismdash cuyo tratamiento se vuelve maacutes difiacutecil debido a la peacuterdida de eficacia de los antibioacuteticos
bull La resistencia a los antibioacuteticos prolonga las estancias hospitalarias incrementa los costos meacutedicos y aumenta la mortalidad
Antibioacuteticos
WAAAR (World Alliance Againt Antibiotic Resistance ) 2011
bull Representantes de todos los continentes
bull Poliacuteticas Puacuteblicas
bull WHO
bull WO animal Health
bull FAO
bull CDChelliphelliphellip
TODOS
Antibioacuteticos
Causas de la MR
bull ATB actuacutean a nivel de agente etioloacutegico y del microbioma estimulando en ambos la resistencia
bull Las bacterias resistentes del microbioma persisten largos periacuteodos y pueden tranferirse a otros pacientes a la comunidad y al ambiente
bull Relacioacuten estrecha entre uso de ATB y multiresistencia
bull Paises con menos consumo de ATB tienen menos problemas de multiresistencia
BMJ 2010 340c2096
Antibioacuteticos
Antibioacuteticos
Nintildeos
bull Farmacodinamia en poblacioacuten pediaacutetrica
bull Dosis en pediatriacutea
bull Falta de investigacioacuten un problema para tener dosis efectivas y seguras en pediatriacutea
bull Uso no autorizado para faacutermacos en pediatriacutea Off-label
bull No todos los antibioacuteticos en formulacioacuten pediaacutetrica
Off- label
bull Edad
bull Peso
bull Sin informacioacuten en nintildeos
bull Otra indicacioacuten
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Distribucioacuten
bull Contenido corporal de agua La fraccioacuten de agua corporal total es muy alta en el feto y se va reduciendo a partir del nacimiento en paralelo al aumento del porcentaje de grasa corporal
bull Concentracioacuten de proteiacutenas plasmaacuteticas La unioacuten a proteiacutenas se encuentra reducida en neonatos
bull Permeabilidad de las membranas maacutes permeables en RN y hasta los 12-14 antildeos
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Absorcioacuten oral de medicamentos
bull Cambios en el pH intraluminal gaacutestrico
bull Vaciamiento gaacutestrico maacutes lento
bull Cambios en la flora bacteriana del intestino
bull Cambios en la funcioacuten biliar
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
PARENTERAL
bull Costos antibioacuteticos ev son hasta 20 veces maacutes caros
bull 35 gastos en medicamentos en pacientes hospitalizados
bull Mitos maacutes seguros
ORAL
bull Adherencia 1-2 de cada 3 no finaliza tratamiento
bull Penicilina y St pyogenes 3 diacuteas 44 6 dia 29 9 dia 18
bull Miedo a recaiacuteda
bull Mitos que tratamientos cortos aumentan la resistencia (meacutedicos)
Rev Chil Infect 201633(2)177-186 Bernal-Vargas M
Antibioacuteticos
Switch a oral
bull La viacutea ideal de administracioacuten de cualquier antibioacutetico es aquella que alcance niveles plasmaacuteticos suficientes para el efecto deseado
bull Terapia secuencial mismo ATB (Ciprofloxacino EV ndash oral)
bull Terapia de cambio ATB EV ndash Oral no es igual pero la misma potencia (Ceftriaxone- Cefixime)
bull Terapia de reduccioacuten ATB EV ndash Oral no tiene la misma actividad (Cefotaxima-Ciprofloxacino)
J Pharmacol Pharmacothe2014Apr-Jun5(2) CyriacJM
AntibioacuteticosOral debe alcanzar niveles plasmaacuteticos similares a EV
ATB orales elegibles con 60-90 biodisponibilidad
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
Antibioacuteticos
J
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
AntibioacuteticosOMS
bull La resistencia a los antibioacuteticos es hoy una de las mayores amenazas para la salud mundial la seguridad alimentaria y el desarrollo
bull La resistencia a los antibioacuteticos puede afectar a cualquier persona sea cual sea su edad o el paiacutes en el que viva
bull La resistencia a los antibioacuteticos es un fenoacutemeno natural aunque el uso indebido de estos faacutermacos en el ser humano y los animales estaacute acelerando el proceso
bull Cada vez es mayor el nuacutemero de infecciones mdashpor ejemplo neumoniacutea tuberculosis gonorrea y salmonelosismdash cuyo tratamiento se vuelve maacutes difiacutecil debido a la peacuterdida de eficacia de los antibioacuteticos
bull La resistencia a los antibioacuteticos prolonga las estancias hospitalarias incrementa los costos meacutedicos y aumenta la mortalidad
Antibioacuteticos
WAAAR (World Alliance Againt Antibiotic Resistance ) 2011
bull Representantes de todos los continentes
bull Poliacuteticas Puacuteblicas
bull WHO
bull WO animal Health
bull FAO
bull CDChelliphelliphellip
TODOS
Antibioacuteticos
Causas de la MR
bull ATB actuacutean a nivel de agente etioloacutegico y del microbioma estimulando en ambos la resistencia
bull Las bacterias resistentes del microbioma persisten largos periacuteodos y pueden tranferirse a otros pacientes a la comunidad y al ambiente
bull Relacioacuten estrecha entre uso de ATB y multiresistencia
bull Paises con menos consumo de ATB tienen menos problemas de multiresistencia
BMJ 2010 340c2096
Antibioacuteticos
Antibioacuteticos
Nintildeos
bull Farmacodinamia en poblacioacuten pediaacutetrica
bull Dosis en pediatriacutea
bull Falta de investigacioacuten un problema para tener dosis efectivas y seguras en pediatriacutea
bull Uso no autorizado para faacutermacos en pediatriacutea Off-label
bull No todos los antibioacuteticos en formulacioacuten pediaacutetrica
Off- label
bull Edad
bull Peso
bull Sin informacioacuten en nintildeos
bull Otra indicacioacuten
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Distribucioacuten
bull Contenido corporal de agua La fraccioacuten de agua corporal total es muy alta en el feto y se va reduciendo a partir del nacimiento en paralelo al aumento del porcentaje de grasa corporal
bull Concentracioacuten de proteiacutenas plasmaacuteticas La unioacuten a proteiacutenas se encuentra reducida en neonatos
bull Permeabilidad de las membranas maacutes permeables en RN y hasta los 12-14 antildeos
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Absorcioacuten oral de medicamentos
bull Cambios en el pH intraluminal gaacutestrico
bull Vaciamiento gaacutestrico maacutes lento
bull Cambios en la flora bacteriana del intestino
bull Cambios en la funcioacuten biliar
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
PARENTERAL
bull Costos antibioacuteticos ev son hasta 20 veces maacutes caros
bull 35 gastos en medicamentos en pacientes hospitalizados
bull Mitos maacutes seguros
ORAL
bull Adherencia 1-2 de cada 3 no finaliza tratamiento
bull Penicilina y St pyogenes 3 diacuteas 44 6 dia 29 9 dia 18
bull Miedo a recaiacuteda
bull Mitos que tratamientos cortos aumentan la resistencia (meacutedicos)
Rev Chil Infect 201633(2)177-186 Bernal-Vargas M
Antibioacuteticos
Switch a oral
bull La viacutea ideal de administracioacuten de cualquier antibioacutetico es aquella que alcance niveles plasmaacuteticos suficientes para el efecto deseado
bull Terapia secuencial mismo ATB (Ciprofloxacino EV ndash oral)
bull Terapia de cambio ATB EV ndash Oral no es igual pero la misma potencia (Ceftriaxone- Cefixime)
bull Terapia de reduccioacuten ATB EV ndash Oral no tiene la misma actividad (Cefotaxima-Ciprofloxacino)
J Pharmacol Pharmacothe2014Apr-Jun5(2) CyriacJM
AntibioacuteticosOral debe alcanzar niveles plasmaacuteticos similares a EV
ATB orales elegibles con 60-90 biodisponibilidad
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
Antibioacuteticos
J
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
WAAAR (World Alliance Againt Antibiotic Resistance ) 2011
bull Representantes de todos los continentes
bull Poliacuteticas Puacuteblicas
bull WHO
bull WO animal Health
bull FAO
bull CDChelliphelliphellip
TODOS
Antibioacuteticos
Causas de la MR
bull ATB actuacutean a nivel de agente etioloacutegico y del microbioma estimulando en ambos la resistencia
bull Las bacterias resistentes del microbioma persisten largos periacuteodos y pueden tranferirse a otros pacientes a la comunidad y al ambiente
bull Relacioacuten estrecha entre uso de ATB y multiresistencia
bull Paises con menos consumo de ATB tienen menos problemas de multiresistencia
BMJ 2010 340c2096
Antibioacuteticos
Antibioacuteticos
Nintildeos
bull Farmacodinamia en poblacioacuten pediaacutetrica
bull Dosis en pediatriacutea
bull Falta de investigacioacuten un problema para tener dosis efectivas y seguras en pediatriacutea
bull Uso no autorizado para faacutermacos en pediatriacutea Off-label
bull No todos los antibioacuteticos en formulacioacuten pediaacutetrica
Off- label
bull Edad
bull Peso
bull Sin informacioacuten en nintildeos
bull Otra indicacioacuten
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Distribucioacuten
bull Contenido corporal de agua La fraccioacuten de agua corporal total es muy alta en el feto y se va reduciendo a partir del nacimiento en paralelo al aumento del porcentaje de grasa corporal
bull Concentracioacuten de proteiacutenas plasmaacuteticas La unioacuten a proteiacutenas se encuentra reducida en neonatos
bull Permeabilidad de las membranas maacutes permeables en RN y hasta los 12-14 antildeos
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Absorcioacuten oral de medicamentos
bull Cambios en el pH intraluminal gaacutestrico
bull Vaciamiento gaacutestrico maacutes lento
bull Cambios en la flora bacteriana del intestino
bull Cambios en la funcioacuten biliar
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
PARENTERAL
bull Costos antibioacuteticos ev son hasta 20 veces maacutes caros
bull 35 gastos en medicamentos en pacientes hospitalizados
bull Mitos maacutes seguros
ORAL
bull Adherencia 1-2 de cada 3 no finaliza tratamiento
bull Penicilina y St pyogenes 3 diacuteas 44 6 dia 29 9 dia 18
bull Miedo a recaiacuteda
bull Mitos que tratamientos cortos aumentan la resistencia (meacutedicos)
Rev Chil Infect 201633(2)177-186 Bernal-Vargas M
Antibioacuteticos
Switch a oral
bull La viacutea ideal de administracioacuten de cualquier antibioacutetico es aquella que alcance niveles plasmaacuteticos suficientes para el efecto deseado
bull Terapia secuencial mismo ATB (Ciprofloxacino EV ndash oral)
bull Terapia de cambio ATB EV ndash Oral no es igual pero la misma potencia (Ceftriaxone- Cefixime)
bull Terapia de reduccioacuten ATB EV ndash Oral no tiene la misma actividad (Cefotaxima-Ciprofloxacino)
J Pharmacol Pharmacothe2014Apr-Jun5(2) CyriacJM
AntibioacuteticosOral debe alcanzar niveles plasmaacuteticos similares a EV
ATB orales elegibles con 60-90 biodisponibilidad
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
Antibioacuteticos
J
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Causas de la MR
bull ATB actuacutean a nivel de agente etioloacutegico y del microbioma estimulando en ambos la resistencia
bull Las bacterias resistentes del microbioma persisten largos periacuteodos y pueden tranferirse a otros pacientes a la comunidad y al ambiente
bull Relacioacuten estrecha entre uso de ATB y multiresistencia
bull Paises con menos consumo de ATB tienen menos problemas de multiresistencia
BMJ 2010 340c2096
Antibioacuteticos
Antibioacuteticos
Nintildeos
bull Farmacodinamia en poblacioacuten pediaacutetrica
bull Dosis en pediatriacutea
bull Falta de investigacioacuten un problema para tener dosis efectivas y seguras en pediatriacutea
bull Uso no autorizado para faacutermacos en pediatriacutea Off-label
bull No todos los antibioacuteticos en formulacioacuten pediaacutetrica
Off- label
bull Edad
bull Peso
bull Sin informacioacuten en nintildeos
bull Otra indicacioacuten
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Distribucioacuten
bull Contenido corporal de agua La fraccioacuten de agua corporal total es muy alta en el feto y se va reduciendo a partir del nacimiento en paralelo al aumento del porcentaje de grasa corporal
bull Concentracioacuten de proteiacutenas plasmaacuteticas La unioacuten a proteiacutenas se encuentra reducida en neonatos
bull Permeabilidad de las membranas maacutes permeables en RN y hasta los 12-14 antildeos
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Absorcioacuten oral de medicamentos
bull Cambios en el pH intraluminal gaacutestrico
bull Vaciamiento gaacutestrico maacutes lento
bull Cambios en la flora bacteriana del intestino
bull Cambios en la funcioacuten biliar
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
PARENTERAL
bull Costos antibioacuteticos ev son hasta 20 veces maacutes caros
bull 35 gastos en medicamentos en pacientes hospitalizados
bull Mitos maacutes seguros
ORAL
bull Adherencia 1-2 de cada 3 no finaliza tratamiento
bull Penicilina y St pyogenes 3 diacuteas 44 6 dia 29 9 dia 18
bull Miedo a recaiacuteda
bull Mitos que tratamientos cortos aumentan la resistencia (meacutedicos)
Rev Chil Infect 201633(2)177-186 Bernal-Vargas M
Antibioacuteticos
Switch a oral
bull La viacutea ideal de administracioacuten de cualquier antibioacutetico es aquella que alcance niveles plasmaacuteticos suficientes para el efecto deseado
bull Terapia secuencial mismo ATB (Ciprofloxacino EV ndash oral)
bull Terapia de cambio ATB EV ndash Oral no es igual pero la misma potencia (Ceftriaxone- Cefixime)
bull Terapia de reduccioacuten ATB EV ndash Oral no tiene la misma actividad (Cefotaxima-Ciprofloxacino)
J Pharmacol Pharmacothe2014Apr-Jun5(2) CyriacJM
AntibioacuteticosOral debe alcanzar niveles plasmaacuteticos similares a EV
ATB orales elegibles con 60-90 biodisponibilidad
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
Antibioacuteticos
J
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Antibioacuteticos
Nintildeos
bull Farmacodinamia en poblacioacuten pediaacutetrica
bull Dosis en pediatriacutea
bull Falta de investigacioacuten un problema para tener dosis efectivas y seguras en pediatriacutea
bull Uso no autorizado para faacutermacos en pediatriacutea Off-label
bull No todos los antibioacuteticos en formulacioacuten pediaacutetrica
Off- label
bull Edad
bull Peso
bull Sin informacioacuten en nintildeos
bull Otra indicacioacuten
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Distribucioacuten
bull Contenido corporal de agua La fraccioacuten de agua corporal total es muy alta en el feto y se va reduciendo a partir del nacimiento en paralelo al aumento del porcentaje de grasa corporal
bull Concentracioacuten de proteiacutenas plasmaacuteticas La unioacuten a proteiacutenas se encuentra reducida en neonatos
bull Permeabilidad de las membranas maacutes permeables en RN y hasta los 12-14 antildeos
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Absorcioacuten oral de medicamentos
bull Cambios en el pH intraluminal gaacutestrico
bull Vaciamiento gaacutestrico maacutes lento
bull Cambios en la flora bacteriana del intestino
bull Cambios en la funcioacuten biliar
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
PARENTERAL
bull Costos antibioacuteticos ev son hasta 20 veces maacutes caros
bull 35 gastos en medicamentos en pacientes hospitalizados
bull Mitos maacutes seguros
ORAL
bull Adherencia 1-2 de cada 3 no finaliza tratamiento
bull Penicilina y St pyogenes 3 diacuteas 44 6 dia 29 9 dia 18
bull Miedo a recaiacuteda
bull Mitos que tratamientos cortos aumentan la resistencia (meacutedicos)
Rev Chil Infect 201633(2)177-186 Bernal-Vargas M
Antibioacuteticos
Switch a oral
bull La viacutea ideal de administracioacuten de cualquier antibioacutetico es aquella que alcance niveles plasmaacuteticos suficientes para el efecto deseado
bull Terapia secuencial mismo ATB (Ciprofloxacino EV ndash oral)
bull Terapia de cambio ATB EV ndash Oral no es igual pero la misma potencia (Ceftriaxone- Cefixime)
bull Terapia de reduccioacuten ATB EV ndash Oral no tiene la misma actividad (Cefotaxima-Ciprofloxacino)
J Pharmacol Pharmacothe2014Apr-Jun5(2) CyriacJM
AntibioacuteticosOral debe alcanzar niveles plasmaacuteticos similares a EV
ATB orales elegibles con 60-90 biodisponibilidad
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
Antibioacuteticos
J
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Nintildeos
bull Farmacodinamia en poblacioacuten pediaacutetrica
bull Dosis en pediatriacutea
bull Falta de investigacioacuten un problema para tener dosis efectivas y seguras en pediatriacutea
bull Uso no autorizado para faacutermacos en pediatriacutea Off-label
bull No todos los antibioacuteticos en formulacioacuten pediaacutetrica
Off- label
bull Edad
bull Peso
bull Sin informacioacuten en nintildeos
bull Otra indicacioacuten
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Distribucioacuten
bull Contenido corporal de agua La fraccioacuten de agua corporal total es muy alta en el feto y se va reduciendo a partir del nacimiento en paralelo al aumento del porcentaje de grasa corporal
bull Concentracioacuten de proteiacutenas plasmaacuteticas La unioacuten a proteiacutenas se encuentra reducida en neonatos
bull Permeabilidad de las membranas maacutes permeables en RN y hasta los 12-14 antildeos
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Absorcioacuten oral de medicamentos
bull Cambios en el pH intraluminal gaacutestrico
bull Vaciamiento gaacutestrico maacutes lento
bull Cambios en la flora bacteriana del intestino
bull Cambios en la funcioacuten biliar
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
PARENTERAL
bull Costos antibioacuteticos ev son hasta 20 veces maacutes caros
bull 35 gastos en medicamentos en pacientes hospitalizados
bull Mitos maacutes seguros
ORAL
bull Adherencia 1-2 de cada 3 no finaliza tratamiento
bull Penicilina y St pyogenes 3 diacuteas 44 6 dia 29 9 dia 18
bull Miedo a recaiacuteda
bull Mitos que tratamientos cortos aumentan la resistencia (meacutedicos)
Rev Chil Infect 201633(2)177-186 Bernal-Vargas M
Antibioacuteticos
Switch a oral
bull La viacutea ideal de administracioacuten de cualquier antibioacutetico es aquella que alcance niveles plasmaacuteticos suficientes para el efecto deseado
bull Terapia secuencial mismo ATB (Ciprofloxacino EV ndash oral)
bull Terapia de cambio ATB EV ndash Oral no es igual pero la misma potencia (Ceftriaxone- Cefixime)
bull Terapia de reduccioacuten ATB EV ndash Oral no tiene la misma actividad (Cefotaxima-Ciprofloxacino)
J Pharmacol Pharmacothe2014Apr-Jun5(2) CyriacJM
AntibioacuteticosOral debe alcanzar niveles plasmaacuteticos similares a EV
ATB orales elegibles con 60-90 biodisponibilidad
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
Antibioacuteticos
J
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Adultos Nintildeos
Distribucioacuten
bull Contenido corporal de agua La fraccioacuten de agua corporal total es muy alta en el feto y se va reduciendo a partir del nacimiento en paralelo al aumento del porcentaje de grasa corporal
bull Concentracioacuten de proteiacutenas plasmaacuteticas La unioacuten a proteiacutenas se encuentra reducida en neonatos
bull Permeabilidad de las membranas maacutes permeables en RN y hasta los 12-14 antildeos
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
Adultos Nintildeos
Absorcioacuten oral de medicamentos
bull Cambios en el pH intraluminal gaacutestrico
bull Vaciamiento gaacutestrico maacutes lento
bull Cambios en la flora bacteriana del intestino
bull Cambios en la funcioacuten biliar
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
PARENTERAL
bull Costos antibioacuteticos ev son hasta 20 veces maacutes caros
bull 35 gastos en medicamentos en pacientes hospitalizados
bull Mitos maacutes seguros
ORAL
bull Adherencia 1-2 de cada 3 no finaliza tratamiento
bull Penicilina y St pyogenes 3 diacuteas 44 6 dia 29 9 dia 18
bull Miedo a recaiacuteda
bull Mitos que tratamientos cortos aumentan la resistencia (meacutedicos)
Rev Chil Infect 201633(2)177-186 Bernal-Vargas M
Antibioacuteticos
Switch a oral
bull La viacutea ideal de administracioacuten de cualquier antibioacutetico es aquella que alcance niveles plasmaacuteticos suficientes para el efecto deseado
bull Terapia secuencial mismo ATB (Ciprofloxacino EV ndash oral)
bull Terapia de cambio ATB EV ndash Oral no es igual pero la misma potencia (Ceftriaxone- Cefixime)
bull Terapia de reduccioacuten ATB EV ndash Oral no tiene la misma actividad (Cefotaxima-Ciprofloxacino)
J Pharmacol Pharmacothe2014Apr-Jun5(2) CyriacJM
AntibioacuteticosOral debe alcanzar niveles plasmaacuteticos similares a EV
ATB orales elegibles con 60-90 biodisponibilidad
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
Antibioacuteticos
J
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Adultos Nintildeos
Absorcioacuten oral de medicamentos
bull Cambios en el pH intraluminal gaacutestrico
bull Vaciamiento gaacutestrico maacutes lento
bull Cambios en la flora bacteriana del intestino
bull Cambios en la funcioacuten biliar
Rev Chil Clin Condes 201627(5) 652-659 QF CGonzaacutelez
Antibioacuteticos
PARENTERAL
bull Costos antibioacuteticos ev son hasta 20 veces maacutes caros
bull 35 gastos en medicamentos en pacientes hospitalizados
bull Mitos maacutes seguros
ORAL
bull Adherencia 1-2 de cada 3 no finaliza tratamiento
bull Penicilina y St pyogenes 3 diacuteas 44 6 dia 29 9 dia 18
bull Miedo a recaiacuteda
bull Mitos que tratamientos cortos aumentan la resistencia (meacutedicos)
Rev Chil Infect 201633(2)177-186 Bernal-Vargas M
Antibioacuteticos
Switch a oral
bull La viacutea ideal de administracioacuten de cualquier antibioacutetico es aquella que alcance niveles plasmaacuteticos suficientes para el efecto deseado
bull Terapia secuencial mismo ATB (Ciprofloxacino EV ndash oral)
bull Terapia de cambio ATB EV ndash Oral no es igual pero la misma potencia (Ceftriaxone- Cefixime)
bull Terapia de reduccioacuten ATB EV ndash Oral no tiene la misma actividad (Cefotaxima-Ciprofloxacino)
J Pharmacol Pharmacothe2014Apr-Jun5(2) CyriacJM
AntibioacuteticosOral debe alcanzar niveles plasmaacuteticos similares a EV
ATB orales elegibles con 60-90 biodisponibilidad
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
Antibioacuteticos
J
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
PARENTERAL
bull Costos antibioacuteticos ev son hasta 20 veces maacutes caros
bull 35 gastos en medicamentos en pacientes hospitalizados
bull Mitos maacutes seguros
ORAL
bull Adherencia 1-2 de cada 3 no finaliza tratamiento
bull Penicilina y St pyogenes 3 diacuteas 44 6 dia 29 9 dia 18
bull Miedo a recaiacuteda
bull Mitos que tratamientos cortos aumentan la resistencia (meacutedicos)
Rev Chil Infect 201633(2)177-186 Bernal-Vargas M
Antibioacuteticos
Switch a oral
bull La viacutea ideal de administracioacuten de cualquier antibioacutetico es aquella que alcance niveles plasmaacuteticos suficientes para el efecto deseado
bull Terapia secuencial mismo ATB (Ciprofloxacino EV ndash oral)
bull Terapia de cambio ATB EV ndash Oral no es igual pero la misma potencia (Ceftriaxone- Cefixime)
bull Terapia de reduccioacuten ATB EV ndash Oral no tiene la misma actividad (Cefotaxima-Ciprofloxacino)
J Pharmacol Pharmacothe2014Apr-Jun5(2) CyriacJM
AntibioacuteticosOral debe alcanzar niveles plasmaacuteticos similares a EV
ATB orales elegibles con 60-90 biodisponibilidad
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
Antibioacuteticos
J
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Switch a oral
bull La viacutea ideal de administracioacuten de cualquier antibioacutetico es aquella que alcance niveles plasmaacuteticos suficientes para el efecto deseado
bull Terapia secuencial mismo ATB (Ciprofloxacino EV ndash oral)
bull Terapia de cambio ATB EV ndash Oral no es igual pero la misma potencia (Ceftriaxone- Cefixime)
bull Terapia de reduccioacuten ATB EV ndash Oral no tiene la misma actividad (Cefotaxima-Ciprofloxacino)
J Pharmacol Pharmacothe2014Apr-Jun5(2) CyriacJM
AntibioacuteticosOral debe alcanzar niveles plasmaacuteticos similares a EV
ATB orales elegibles con 60-90 biodisponibilidad
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
Antibioacuteticos
J
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
AntibioacuteticosOral debe alcanzar niveles plasmaacuteticos similares a EV
ATB orales elegibles con 60-90 biodisponibilidad
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
Antibioacuteticos
J
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
J
J pharmacol Pharmacothe2014Apr-Jun5(2) Cyriac J M
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
AntibioacuteticosAdvantages of early IV to Oral Switch
The oral route of administration for antimicrobials is preferred to the IV route wherever possible as oral administration is associated with
Decreased risk of infection from IV lines
Decreased risk of thrombophlebitis
Significantly less cost than IV therapy
Reduction in hidden costs (diluents equipment needles nursing time)
More patient friendly
May lead to earlier discharge A recent paediatric study found that patients commenced on oral antibiotics had a mean shorter length of stay in hospital compared to patients commenced on IV antibiotics
Childrens Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Criteria for considering IV to Oral switch in children
bull Patients should be reviewed at 24 to 48 hours The following criteria are helpful when deciding if oral therapy is appropriate
bull Antibiotic treatment is still indicated
bull Oral fluidsfoods are tolerated and no reason to believe that poor oral absorption may be a problem (eg vomiting diarrhoea short gut syndrome active gastro-intestinal bleeding)
bull Temperature less than 375degC for 24 to 48 hours
bull No signs of sepsis
bull An appropriate oral antibiotic is available
bull Extra high tissue antibiotic concentrations or a prolonged course of IV antibiotics are not essential
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Criterios para pasar a viacutea oral en nintildeos
bull Estabilidad a las 48 hrs- 72 hrs
bull ATB estaacuten indicados
bull No hay problema con tolerancia oral
bull Afebril al menos 24 hrs
bull ATB oral disponible
bull Consentimiento de tutores
bull ControlAntimicrobial treatment Early Intravenous to Oral Switch-Paediatric Guideline Queensland Hospital
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
When is early IV to Oral switch NOT appropriate
Some conditions require a prolonged course of intravenous antibiotics or very high tissue concentrations Early IV to oral switch is not considered appropriate in the following conditions
bull Bacterial Meningitis
bull Blood stream infections
bull Cystic fibrosis
bull Deep abscesses
bull Endocarditis
bull Immunosuppressed patients (may be considered on advice of Paediatric Infectious Diseases team)
Children s Health Queensland Hospital and Health Service 2016
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Antibioacuteticos de uso restringido en menores de 12 antildeos
bull Tetraciclinas y glicilciclinas Doxicilina Minocidina Tigeciclina
bull Oxazolidinonas Linezolid precaucioacuten
bull Daptomicina pocos datos precaucioacuten
bull Fluoroquinolonas en nintildeos o adolescentes soacutelo se justificariacutea en circunstancias especiales en las que la infeccioacuten es causada por un patoacutegeno multirresistenteyo no existen alternativas efectivas y seguras
Enferm Infecc Microbiol Clin 201028310-20 -
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
No disponibles en formulacioacuten pediaacutetrica en Chilebull Clindamicinabull Linezolidebull Ciprofloxacinobull Levofloxacinobull Moxifloxacinobull Cefazolinabull Lincomicina
PR Vademecum Chile
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Duracioacutenhelliphellip
bull Regla de ldquoorordquo nuacutemeros impares 5-7
bull Muacuteltiplos de 5-7 o 10-14 diacuteas
bull Nuacutemeros pares excepcional
bull Objetivo pasar de regla de oro a la evidenciahelliphellippero
bull An Unsupported Preference for Intravenous Antibiotics
Ho Kwong Li1 Ambrose Agweyu2 Mike English23 Philip Bejon134
bull Why Do Physician Unnecessarily Prolong Antibiotics
Infection Diseases in Clinical Practice 22(6) 2014 Wlodaver C
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Importancia de limitar la duracioacuten de los tratamientos antibioacuteticos
bull Cada diacutea antildeade probabilidad de resistencia
bull 25000 pacientes en Europa y 23000 en EEUU antildeo mueren por multiresistentes
bull Costo de la MR asciende a 15 billones de Euros
bull Disponibilidad restringida de antibioacuteticos
bull Nuevos antibioacuteticos lento y a mediano plazo
WAAAR (World Alliance Againt Antibiotic Resistance 2011 )
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Relationship between the probability of the development of resistance and treatment duration (days) Solid line data for cases in which the AUC0ndash24MIC ratio was lt100 small dashed line data for type I β-lactamase-producing gram-negative rods treated with β-lactam monotherapy large dashed line data for cases in which the AUC0ndash
24MIC ratio was ge100 Antimicrob Agents Chemother 1998 Mar 42(3) 521ndash527 Jennifer K Thomas1
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Simulation of the IBM over 1 year when (left) treatment starts on day 3 and stops on day 21 and (right) treatment starts on day 1 and stops on day 8 In the former case the resistant strain becomes endemic and in the latter case both strains are eliminated All parameters have baseline values as in J Theor Biol Author manuscript available in PMC 2008 Jun 19 Erika MC DrsquoAgata
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
bull Agente actividad bactericida o bacteriostaacutetica
Carga mayor carga (EBSA)
Capacidad de penetrar al tejido y permanecer
bull Severidad de la infeccioacuten mayor severidad maacutes largo
bull Respuesta del paciente mejoriacutea pensar en suspender
bull Co-morbilidades
bull Respuesta inflamatoria PCR- Procalcitonina
bull Evidencia no siempre corto es mejor OMA en nintildeos
Duracioacuten de terapia antibioacutetica principios generales
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Figure 1 Open in figure viewerPowerPoint
Procalcitonin (PCT) kinetics CRP = C‐reactive protein IL = interleukin TNF = tumor necrosis factor
Reproduced from VIDAS BRAHMS PCT Available from
httpwwwbiomerieux-diagnosticscomvidas-brahms-pct Accessed January 2 2018
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Procalcitonin concentrations among
children hospitalized with community-
acquired pneumonia stratified by patterns
of microbiological detection The solid gray
lines inside the boxes denote the median
and the borders of the boxes denote the
interquartile range Vertical lines extending
above and below the boxes are 15 times
the interquartile range Individual
observations are represented by small gray dots
Journal of the Pediatric Infectious Diseases Society Volume 7 Issue 1 19 February 2018 Pages 46ndash53httpsdoi-orgezproxypuccl101093jpidspiw091
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Duracioacuten de esquemas terapeuacuteticos en nintildeos
We aimed to determine in children younger than 18 years with bacterial infections the minimum intravenous and total antibiotic duration required to achieve outcomes similar to or better than those with traditional longer durations administered for specifi c infections We then aimed to make evidence-based recommendations for optimal intravenous and total antibiotic duration and criteria for intravenous to oral switch
The Lancet Infection DiseasesJunio 2016 Brandon JM
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Duracioacuten
bull Revisioacuten Lancet Infection Diseases
bull Nintildeos menores de 18 antildeos infeccioacuten bacteriana probada
bull Duracioacuten de terapia ev y total tipo de infeccioacuten resultados de la infeccioacuten y complicaciones
bull 170 estudios 36randomizados controlados o revisioacuten sistematica
bull Resultados seguacuten patologiacutea
wwwthelancetcominfection Online June 2016 Brendan J McMullan
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
Bacteriemia
bull Meningococo 4-5 diacuteas EV
bull Neumococo 7-10 diacuteas
bull Gram negativos 10 diacuteas EV
bull CVV sin remocioacuten 10-14 diacuteas con remocioacuten 5-7 diacuteas EV
bull EBSA no hay suficientes estudios en nintildeos EV
1 estudio retrospectivo no mostroacute diferencias entre 4-8 semanas Escasa experiencia con viacutea oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
bull SNC evidencia deacutebil
Lysteria y Gram negativos fallas con menos de 14 diacuteas recomendacioacuten 21 diacuteas EV
ATB intratecales no recomendados
bull Abcesos cerebral 2 -4 sem ev y 4 semanas oral
bull VVP retiro de VVP 10diacuteas ev y 7 diacuteas post LCR negativo
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
bull IRA
bull Absceso PAsi drena 2 diacuteas ev maacutes 5 diacuteas oral
si no se drena 2-3 dias ev maacutes 7-10 diacuteas oral
bull Absceso RF drenar maacutes 3-6 dias ev y 7-10 oral (cliacutenica con TAC 3-6 sem y resultado es id)
bull Mastoiditis 4-7 diacuteas ev maacutes 7-9 oral Sin dif entre manejo mixto a solo ev
bull Sinusitis severa (fiebre alta CEG ) 3-7 diacuteas oral En leve no hay diferencia entre tratar y no
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
bull Neumoniacutea comunitaria no complicada
2-59 meses 5 -7 diacuteas oral
12-16 antildeos 3-5 diacuteas oral
bull Neumoniacutea asociada a VM no datos en nintildeos
bull Pleuroneumonia no datos en nintildeos En adultos curso ev oral duracioacuten La resistencia de neumococo no significa maacutes prolongado
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
bull Infecciones muacutesculo esqueleacuteticas
bull OM 3-4 diacuteas ev mas 16-26 diacuteas oral
bull OM croacutenica pocos datos 3 diacuteas ev maacutes 6 sem oral
bull AS 2-4 diacuteas ev maacutes 10 oral
bull Piomiositis 4-7 ev maacutes 2-6 sem oral
wwwthelancetcominfection Online June 2016
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
bull Piel y partes blandas
bull Infecciones no complicadas 2-3 ev maacutes 7 diacuteas oral
bull Celulitis preseptal 2-3 ev maacutes 7-8 oral
bull Celulitis post septal 4 diacuteas (rango 2-8) ev maacutes 21 diacuteas total
bull Abscesos drenar dudas si tratar o no
wwwthelancetcominfection Online June 2016
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
AntibioacuteticosAntibioticos
For Children Discharged after Hospitalization for Serious Bacterial Infections Are Orally Administered Antibiotics as Effective as Antibiotics Given Intravenously through a PICC Resultados Marzo 2019
bull 8762 children in the United States between 2 months and 18 years of age They had been in the hospital with a severe infection 2060 had a bone infection 2123 had severe pneumonia and 4579 had a burst appendix
bull The research team looked at medical records from 38 childrenrsquos hospitals over four years The team compared children who took antibiotics by mouth after leaving the hospital with those who had a PICC The team wanted to see
bull Ron Keren MD MPH
bull The Children s Hospital of Philntildeadelphia
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
WAAAR
bull ATB deben ser protegidos
bull ATB no deben ser de libre acceso
bull Deben implementarse guias de uso de ATB a todo nivel
bull Los ATB restringidos deben ser autorizados por Infectoacutelogo
bull Debe revisarse la indicacioacuten al dia 3 de-escalar
bull La duracioacuten debe ser evaluada rigurosamente
bull Monitorizar niveles plasmaacuteticos
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
bull Desafiacuteos
bull Trabajar en equipo infectoacutelogo microbioacutelogo QF autoridades
bull Stewardship o Guiacuteas de uso de ATB
bull Guiacuteas de Switch VV a Oral
bull Determinar la duracioacuten de los tratamientos ATB
bull Comercializar ATB por unidades
bull Conocer MR a nivel local
bull Socializar el problema de MR
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
Antibioacuteticos
AntibioacuteticosAntibiotics the future is short
AntibioacuteticosAntibiotics the future is short
![Tetraciclinas expocicion[1]](https://img.dokumen.tips/doc/110x75/556b4c69d8b42a4c5a8b4861/tetraciclinas-expocicion1.jpg)
