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Objective: To show the preparation process by the Poisoning Working Group of the Spanish Society of Paediatric Emergencies (GTI-SEUP), of the list of things “not to do” for a paediatric patient who has been exposed to a potentially toxic substance. Method: The preparation process of the list was carried out in three phases. First: “Brainstorming” that was open to all members of the GTI-SEUP. Second: Recommendations were selected by following modified-Delphi methodology. All participants were asked to rate the proposals (from 1 = strongly disagree to 9 = strongly agree). Those with an average score greater than 8 were accepted (provided that at least two-thirds of the participants had given them a score ≥ 7), and a second consultation was made for the recommendations with an average score between 6 and 8. Third: Writing and creating a consensus of the final document was done. Result: A total of 11 proposals were initially obtained. Thirty-two of the 57 GTI-SEUP participants completed the scoring questionnaire. In the first consultation, seven “not to do” recommendations were accepted, and four obtained a doubtful average score (between 6 and 8). After the second consultation, the list was made up of eight recommendations. Two refer to general management, four to gastrointestinal decontamination techniques, and two to the administration of antidotes. Conclusion: The list of actions that should not be taken with a child that has been exposed to a possible poison is a consensus tool, within the GTI-SEUP, to promote improvement in the quality of care offered to these patients. This improvement is based on avoiding unnecessary measures, which can sometimes be harmful to the child. Resumen: Objetivo: Mostrar el proceso de elaboración, dentro del Grupo de Trabajo de Intoxicaciones de la Sociedad Española de Urgencias de Pediatría (GTI-SEUP), de la lista de recomendaciones de “no hacer” ante un paciente pediátrico que ha contactado con una sustancia potencialmente tóxica. Método: El proceso de elaboración de la lista se realizó en 3 fases. Primera: “Lluvia de ideas” abierta a todos los miembros del GTI-SEUP. Segunda: Selección de las recomendaciones, siguiendo una metodología Delphi-modificada. Se solicitó a todos los participantes que puntuasen las propuestas (del 1 = totalmente en desacuerdo al 9 = totalmente de acuerdo). Se aceptaron aquellas con una puntuación media superior a 8 (siempre que al menos 2/3 de los participantes le hubieran otorgado una puntuación ≥ 7) y se realizó una segunda consulta para las recomendaciones con una puntuación media entre 6 y 8. Tercera: Redacción y consenso del documento final. Resultado: Inicialmente se obtuvieron 11 propuestas. Treinta y dos de los 57 participantes del GTI-SEUP respondieron al cuestionario de puntuación. En la primera consulta, fueron aceptadas 7 recomendaciones de “no hacer” y 4 obtuvieron una puntuación media dudosa (entre 6 y 8). Tras la segunda consulta, la lista quedó formada por 8 recomendaciones. Dos hacen referencia al manejo general, 4 a técnicas de descontaminación digestiva y 2 a la administración de antídotos. Conclusión: La lista de acciones que no hay que hacer ante un niño que ha contactado con un posible tóxico es una herramienta consensuada, dentro del GTI-SEUP, para promover una mejora de la calidad asistencial ofrecida a estos pacientes. Dicha mejora se basa en evitar medidas innecesarias, que en ocasiones pueden resultar nocivas para el niño.

Resumen: Objetivo: Mostrar el proceso de elaboración, dentro del Grupo de Trabajo de Intoxicaciones de la Sociedad Española de Urgencias de Pediatría (GTI-SEUP), de la lista de recomendaciones de «no hacer» ante un paciente pediátrico que ha contactado con una sustancia potencialmente tóxica. Método: El proceso de elaboración de la lista se realizó en tres fases. Primera: «Lluvia de ideas» abierta a todos los miembros del GTI-SEUP. Segunda: Selección de las recomendaciones, siguiendo una metodología Delphi-modificada. Se solicitó a todos los participantes que puntuasen las propuestas (del 1 = totalmente en desacuerdo al 9 = totalmente de acuerdo). Se aceptaron aquellas con una puntuación media superior a 8 (siempre que al menos 2/3 de los participantes le hubieran otorgado una puntuación ≥ 7) y se realizó una segunda consulta para las recomendaciones con una puntuación media entre 6 y 8. Tercera: Redacción y consenso del documento final. Resultado: Inicialmente se obtuvieron 11 propuestas; 32 de los 57 participantes del GTI-SEUP respondieron al cuestionario de puntuación. En la primera consulta, fueron aceptadas siete recomendaciones de «no hacer» y cuatro obtuvieron una puntuación media dudosa (entre 6 y 8). Tras la segunda consulta, la lista quedó formada por ocho recomendaciones. Dos hacen referencia al manejo general, cuatro a técnicas de descontaminación digestiva y dos a la administración de antídotos. Conclusión: La lista de acciones que no hay que hacer ante un niño que ha contactado con un posible tóxico es una herramienta consensuada, dentro del GTI-SEUP, para promover una mejora de la calidad asistencial ofrecida a estos pacientes. Dicha mejora se basa en evitar medidas innecesarias, que en ocasiones pueden resultar nocivas para el niño. Abstract: Objective: To show the preparation process by the Poisoning Working Group of the Spanish Society of Paediatric Emergencies (GTI-SEUP), of the list of things «not to do» for a paediatric patient who has been exposed to a potentially toxic substance. Method: The preparation process of the list was carried out in three phases. First: «Brainstorming» that was open to all members of the GTI-SEUP. Second: Recommendations were selected by following modified-Delphi methodology. All participants were asked to rate the proposals (from 1 = strongly disagree to 9 = strongly agree). Those with an average score greater than 8 were accepted (provided that at least two-thirds of the participants had given them a score ≥ 7), and a second consultation was made for the recommendations with an average score between 6 and 8. Third: Writing and creating a consensus of the final document was done. Result: A total of 11 proposals were initially obtained. Thirty-two of the 57 GTI-SEUP participants completed the scoring questionnaire. In the first consultation, seven «not to do» recommendations were accepted, and four obtained a doubtful average score (between 6 and 8). After the second consultation, the list was made up of eight recommendations. Two refer to general management, four to gastrointestinal decontamination techniques, and two to the administration of antidotes. Conclusion: The list of actions that should not be taken with a child that has been exposed to a possible poison is a consensus tool, within the GTI-SEUP, to promote improvement in the quality of care offered to these patients. This improvement is based on avoiding unnecessary measures, which can sometimes be harmful to the child.

Resumen: Se presenta una actualización del documento de consenso sobre el diagnóstico y tratamiento de la faringoamigdalitis aguda, publicado en 2011. Las escalas de predicción clínica no deben ser utilizadas para iniciar antibioterapia, salvo que las pruebas microbiológicas no estén disponibles o exista riesgo de fiebre reumática. No existe ninguna escala que sea mejor que las expuestas en el consenso previo. Se proponen casos en los que se recomienda realizar pruebas microbiológicas, con independencia de los resultados de las escalas. El tratamiento de elección de la faringoamigdalitis estreptocócica es penicilina en dos dosis diarias y durante 10 días. Amoxicilina, en una o dos dosis diarias y durante el mismo tiempo, es la primera alternativa terapéutica. Las cefalosporinas de primera generación son el tratamiento de elección en niños con reacción retardada no grave a penicilina o amoxicilina. En reacciones alérgicas inmediatas deben utilizarse antibióticos no betalactámicos, siendo josamicina y diacetil-midecamicina las mejores opciones. En el fracaso terapéutico bacteriológico, y en el estado de portador, los tratamientos planteados en el consenso previo siguen siendo válidos. Abstract: An update of the Spanish consensus document on the diagnosis and treatment of acute tonsillopharyngitis is presented. Clinical scores should not be used to prescribe antibiotics, unless microbiological tests are not available or there is a child at risk of rheumatic fever. There is no score better than those set out in the previous consensus. Microbiological tests are recommended in proposed cases, regardless of the result of the scores. Penicillin is the treatment of choice, prescribed twice a day for 10 days. Amoxicillin is the first alternative, prescribed once or twice a day for the same time. First-generation cephalosporins are the treatment of choice in children with non-immediate reaction to penicillin or amoxicillin. Josamycin and midecamycin are the best options for children with immediate penicillin allergic reactions, when non-beta-lactam antibiotics should be used. In microbiological treatment failure, and in streptococcal carriers, the treatments proposed in the previous consensus are still applicable.

To show the preparation process by the Poisoning Working Group of the Spanish Society of Paediatric Emergencies (GTI-SEUP), of the list of things «not to do» for a paediatric patient who has been exposed to a potentially toxic substance.The preparation process of the list was carried out in three phases. First: «Brainstorming» that was open to all members of the GTI-SEUP. Second: Recommendations were selected by following modified-Delphi methodology. All participants were asked to rate the proposals (from 1 = strongly disagree to 9 = strongly agree). Those with an average score greater than 8 were accepted (provided that at least two-thirds of the participants had given them a score ≥ 7), and a second consultation was made for the recommendations with an average score between 6 and 8. Third: Writing and creating a consensus of the final document was done.A total of 11 proposals were initially obtained. Thirty-two of the 57 GTI-SEUP participants completed the scoring questionnaire. In the first consultation, seven «not to do» recommendations were accepted, and four obtained a doubtful average score (between 6 and 8). After the second consultation, the list was made up of eight recommendations. Two refer to general management, four to gastrointestinal decontamination techniques, and two to the administration of antidotes.The list of actions that should not be taken with a child that has been exposed to a possible poison is a consensus tool, within the GTI-SEUP, to promote improvement in the quality of care offered to these patients. This improvement is based on avoiding unnecessary measures, which can sometimes be harmful to the child.