Search

Objective: The resistance of Helicobacter pylori to antibiotics is a growing problem in Spain and eradication rates must be improved. The new Spanish consensus considers quadruple therapy with bismuth as first- or second-line therapy. This study evaluated the use of Pylera ® in real-life clinical practice., Patients and Methods: A cross-sectional descriptive study was conducted to evaluate the eradication rate of Helicobacter pylori in patients treated with Pylera ® between March and September 2016. Patients (naïve or with previous treatment failure) were treated for 10 days. Eradication was confirmed using a breath test with urea 30 days or more after treatment. In addition, demographic, clinical-analytical and treatment-related data were collected., Results: A total of 185 patients were included (51.6±16.19 years); 63.8% were women and 9.2% had a family history of gastric cancer. The most frequent indication was dyspepsia (55.1%). Approximately 57.8% received Pylera ® as first-line therapy, while 95.7% received Pylera ® in combination with omeprazole. A first-line eradication rate of 78.15% was observed in the intention-to-treat population (86.6% per protocol). There were no statistically significant differences between naïve patients and those previously treated. Nine patients abandoned the treatment (4.9%), 7 due to mild side effects and 2 due to incorrect dosing., Conclusions: Pylera ® has acceptable eradication rates in first- and second-line therapy and shows a suitable safety profile., (Copyright © 2018 Elsevier España, S.L.U. All rights reserved.)

Lyme disease, caused by Borrelia burgdorferi sensu lato, is a multisystem disease that may occur with rheumatic, dermatological, neurological symptoms and heart diseases. Its most typical lesion is erythema migrans, although not always present. The clinical diagnosis is supported by serology, and treatment is almost always tetracycline in young people and adults. Amoxicillin is most often used in children and pregnant women, and cephalosporins in the presence of neurological signs. The prognosis, with the appropriate treatment, is good. But if not treated promptly, there may be chronic signs, particularly, neurological, which may be disabling. In Spain, where the incidence is low, antimicrobial prophylaxis is indicated the after a tick bite.

Streptococcus pneumoniae infections constitute a public health problem. In our country there is scarce information regarding isolates from bacteraemic episodes in adult population. The antibiotic susceptibility, serotypes and clonal relationship of 56 isolates of S. pneumoniae from adult patients with bacteraemic infections in Concepcion-Talcahuano, Bio-Bio Region, Chile, were studied. Resistance to tetracycline (21.4%), trimethoprim/ sulfamethoxazole (18%), erythromycin (18%), chloramphenicol (7%) and 1 penicillin resistant isolate from a meningeal focus (2%) was found. Also, all the isolates were susceptible to cefotaxime, levofloxacin, moxifloxacin and vancomycin. A wide variety of capsular serotypes was demonstrated, with predominance of serotypes 1, 5, 23F, 7F and 3. The macrorestriction analysis by pulse field electrophoresis revealed 31 electrophoretic patterns and 12 clonal groups, discarding a predominant clone. According to the results, at least, 80% of the S. pneumoniae serotypes isolated from bacteraemic adult patients are included in the available commercial vaccine.

Background: Helicobacter pylori (Hp) infection has been associated with the presence of duodenal ulcer, gastric ulcer and chronic active gastritis. It is also speculated that Hp may have a major role in gastric cancer development. Due to rising antibiotic resistance, probably lack of compliance and the expense of the currently used antimicrobial regimens, it's important to develop efficacious, short-duration and low cost therapies, especially for the treatment of low-income populations from underdeveloped countries. The goal of the present study is to asses the efficacy of two ultrashort antibiotic schemes against Hp infection., Methods: Patients with diagnosis of Hp infection, found in antral gastric biopsies, were included. They were randomly assigned to receive one of the following therapeutic schemes: tetracycline 500 mg qid, furazolidone 100 mg qid and colloidal bismuth subcitrate 120 mg qid for 3 days (Scheme I) or 4 days (Scheme II). Patients were instructed to come back for follow-up at least 8 weeks after starting medication. At the control visit, an upper endoscopy was performed and an average of 3 antral biopsies was taken. Biopsies were stained with hematoxylin-eosin for histological assessment and with Warthin-Starry silver staining for Hp diagnosis. A single experienced pathologist read all biopsies. In both, the initial biopsy and the control one, we evaluated: presence of Hp; presence, depth and grade of chronic gastritis; presence and grade of inflammatory activity; presence, grade and extent of mucinous damage; presence of glandular atrophy, intestinal metaplasia and lymphoid follicles. We also evaluated dyspeptic symptoms prior and after the treatment, and the presence of adverse events., Results: 80 patients were enrolled, 2 were excluded because of intense nausea and vomits, 4 patients didn't follow the indications properly and 8 patients couldn't be contacted for the control visit. From the remaining 66 patients, 32 were assigned to Scheme I and 34 to Scheme II, both groups were comparable. Eradication rate was 68.8% (22/32) (CI = 52.1% - 82.7%) for Scheme I and 88.2% (30/34) (CI = 74.9% - 96.2%), significant higher, for Scheme II. There was decrease of dyspeptic symptoms and significant improvement of the histological pattern for both groups, except for presence of chronic gastritis, intestinal metaplasia, glandular atrophy and lymphoid follicles. Hp eradication was associated with significant symptoms decrease, normal endoscopy raising and improvement of all the histological parameters, except for presence of intestinal metaplasia and glandular atrophy. Treatment was well tolerated, 57.6% of the patients reported only mild adverse events, nausea was the most frequent (19.7%) and there was no difference between schemes., Conclusions: The triple ultrashort duration scheme including tetracycline, furazolidone and bismuth for 4 days is efficacious against Hp, with a high eradication rate (88.2%). The Hp disappearance is followed by improvement in every histological parameter that we evaluated, except for glandular atrophy and intestinal metaplasia; and it's also accompanied by a decrease in dyspeptic symptoms.

Background: The aim of this study was to investigate the sensitivity of Helicobacter pylori to the antibiotics used in its eradication over a period of four years and to determine the influence of previous treatment on sensitivity., Material and Methods: During the period from 1995 to 1998 we determined the sensitivity of 235 consecutive Helicobacter pylori isolates to amoxicillin, metronidazole, clarythromycin and tetracycline by means of E-test methodology. The MIC values found were related with the prior use of eradicating treatment., Results: The percentage of resistant strains were as follows: 23.5% to metronidazole, 12.9% to clarythromycin and 0.7% to tetracycline; none of the strains was resistant to amoxicillin. There were no significant changes in percentage of resistance to the drugs studied over the 4-year period. Resistance to metronidazole and clarythromycin was significantly higher (p 5 0.03 and p < 0.001 respectively) in strains isolated from patients who had received previous treatment., Conclusions: Monitorization of H. pylori sensitivity to the drugs used in its eradication is particularly important in patients who have undergone prior treatment.

Background: To evaluate the efficacy of a multistep strategy for Helicobacter pylori (HP) eradication., Patients and Method: 151 patients, with peptic ulcer or chronic gastritis, infected by HP, treated (first-step) with omeprazole (20 mg/12 h), clarithromycin (500 mg/12 h) and amoxycillin (1 g/12 h) for a week (OCA) and second-step (first-step failures) with omeprazole (20 mg/12 h), metronidazole (500 mg/12 h), tetracyclin (500 mg/6 h) and bismuth (120 mg/6 h) for two weeks., Results: Intention-to-treat analysis, eradication was achieved with OCA in 78.1% (CI 95%: 71.6-84.7) and OMTB in 90.3% (CI 95%: 74.2-98), with an cumulative eradication rate of 96.7% (CI 95%: 92.4-98.9)., Conclusions: The efficacy of multistep strategy is high. Therapy with OMTB its a good option after failure with OCA.

Background: To analyze cost-effectiveness of two different strategies to treat H. pylori infection in peptic ulcer in the primary care setting., Patients and Methods: Consecutive patients with endoscopic diagnosis of peptic ulcer were randomized to one of two strategies: a) treatment during 7 days with omeprazole, tetracycline, metronidazole and bismuth subcitrate ("quadruple" therapy) and if failure second-line treatment with omeprazole, amoxycillin and clarithromycin during 7 days (OCA7), and b) initial treatment with OCA7 and if failure treatment with "quadruple therapy". End point was eradication 8 weeks after last treatment dose. Direct and indirect costs were estimated (euros, 1997) and a cost-effectiveness analysis using a decision-tree model was undertaken after real clinical data. 95% confidence intervals are given., Results: After screening 255 patients, 97 were finally included. 48 patients were given strategy a and 49 strategy b. Eradication was obtained (intention-to-treat) in 72.9% (CI 95%: 58.2-84.7) in group a versus 91.8% (CI 95%: 80.4-97.7) (p < 0.05) in group b. Mean cost per case treated was lower in group a (237 versus 268 euros) but cost per case eradicated was lower in group b (320 versus 296 euros). The cost was primarily determined by efficacy., Conclusions: Treatment with OCA7 followed by rescue with "quadruple" therapy if failure is more efficient in our area that the inverse strategy. Efficiency is mostly determined by efficacy.

Objective: To estimate the frequency of H. pylori clinical isolates resistant to six commonly used antimicrobials., Design: Cross-sectional observational study., Setting: A tertiary-referral health care institution in Mexico City., Participants: 31 isolates of H. pylori from 31 patients with chronic antral gastritis were obtained from gastric mucosal biopsy specimens., Main Outcome Measure: The Minimum Inhibitory Concentration (MIC) to ampicillin, amoxycillin, tetracycline, doxycycline, metronidazole and to colloidal bismuth subcitrate was determined by the agar plate dilution test., Results: All isolates showed to be susceptible to the former four antibiotics but only in 46% and 55% growth was inhibited by 8 micrograms/mL and 16 micrograms/mL of metronidazole, respectively. All isolates were inhibited by < or = 128 micrograms/mL of bismuth. A 50% increase in the percentage of metronidazole-resistant isolates (MIC > or = 8 micrograms/mL) between 1988 to 1992 was observed., Conclusion: There is a need of future studies in our setting aimed at assessing the cost/effectiveness of diverse H. pylori-associated peptic ulcer treatment options.

We inform of one case of fever and characteristic hepatic granuloma in which the final diagnosis was Q fever. The interest of this case lies in the fact that the patient did not have the usual epidemiological antecedent and its typical clinical presentation.

Human ehrlichiosis is a zoonotic disease, caused by a rickettsia that infects leukocytes. It was described for the first time in the United States of America in 1986. More than 300 cases have been reported in that country. One case has been reported in Portugal, two in France and one more in a tourist coming from Mali (Africa). In Venezuela, a tropical country, where ehrlichiosis is endemic in dogs and horses, the first case of human ehrlichiosis is reported in a seventeen month old girl. She initially had symptoms compatible with a viral illness. Then she developed a rash, acute respiratory failure, hepato-splenomegaly, neurologic abnormalities, renal failure and hematologic alterations including pancytopenia and disseminated intravascular coagulation (DIC). Different diagnoses were given before it was concluded that it was a case of ehrlichiosis. She was treated with tetracycline and very soon recovered. The initial diagnosis was made using buffy coat blood smears stained with Diff Quick Stain. Indirect Immunofluorescence (IFA) test was used to detect antibodies against Ehrlichia chaffeensis (1:126) but not to other rickettsias. Also the presence of platelets with ehrlichia bodies similar to E. platys from dogs, it was demonstrated, in peripheral blood from the child. The presence of these bodies in human platelets has not been previously reported. In this case, it could not be proved that the disease was transmitted by a tick bite. The presence of ehrlichia bodies in platelets from the girl's peripheral blood is also described.

Since 1961 cholera has spread in many countries reaching a pandemic form. Since 1991 Mexico has been involved in this pandemia. Near 20% of all cases of cholera in our country happen in fertile women, so the possibility of the association between cholera and pregnancy is high. We present the case of a pregnant woman, who during her third trimester presented a episode of cholera, developing premature labor. Furthermore is revised the medical literature about the general principles of the management of cholera, and the association between pregnancy and the intestinal infection.

Although the existence of chronic carriers of Vibrio cholerae has been posited, the information in this regard is limited and contradictory. In order to determine the usefulness of the encapsulated string test (enterotest) for detecting V. cholerae in duodenal secretions of biliary origin (biliduodenal secretions), 59 patients (30 males and 29 females) over the age of 15 with clinically and bacteriologically diagnosed cholera were evaluated. All the patients, who were treated at the María Auxiliadora Departmental Hospital in Lima, Peru, were put on the same rehydration regimen and were given 2 g of tetracycline daily for 3 days. Between 24 h and 7 days after completion of the antibiotic treatment the first control tests were performed: culture of biliduodenal secretions obtained using enterotest and culture of feces obtained by rectal swab. No patient had diarrhea at the time of the first test. The biliduodenal secretion cultures revealed the presence of V. cholerae in five patients (8.5%) (four females and one male), while the fecal culture yielded negative results in all cases. One week later the control test was repeated on four of the five patients. All the biliduodenal secretion cultures were negative and only one fecal culture was positive at this stage. The patient in question was subjected to the same control tests one week later and both were negative. It is concluded that enterotest can be a simple, well-tolerated, low-cost method for detecting V. cholerae carriers.

Background: Malignant pleural effusions (MPE) are a common complication in patients with advanced neoplasms. Even though no large series confirming this exist, tetracycline pleurodesis has become the therapy of choice. The aim of this retrospective study was to evaluate its efficacy, adverse effects and possible factors predicting the success of the method., Methods: Between 1985 through 1991, 91 patients with cytologically or histologically confirmed MPE were treated with 1,000-1,500 mg tetracycline pleurodesis. There were 49 females and 42 males, with a mean age of 59 years. The most common malignancies were lung, breast and unknown primary carcinomas. 85% patients complained of dyspnea and the volume of the effusion was moderate in half the cases. 12 variables were analyzed in relation with the probability of response through chi 2 test; survival and recurrence times were calculated with Kaplan and Meier's method., Results: 73 patients were evaluable, with a 67% response rate (22 complete, 27 partial). Time to relapse was significantly higher for partial responses (mean 112 days) than for failures (mean 33 days). 37 patients presented mild complications (pain and fever). Karnofsky performance status (70% or greater), size of the effusion (small or moderate), chest radiograph (only effusion) and pleural LDH (600 U/l or less) attained favourable prognostic significance. Median survival was reached at 6 months., Conclusions: Tetracycline pleurodesis is an effective and well-tolerated paliative treatment for MPE. Along with other known parameters (pleural pH and glucose levels), Karnofsky performance status, size of the effusion, chest radiograph and pleural LDH allow to predict its results and optimize its indications.

Twenty-six patients, aged 38 to 78 years, with testicular hydrocele were treated by aspiration, punction and tetracycline instillation. The cure rate was 79%. Inflammation of the scrotum was observed in all of the cases. Due to recurrence two patients underwent surgery, which revealed a hematocele.

Authors report six cases of boutonneuse Mediterranean fever seen in the last two years. All of them presented fever, malaise, generalised maculopapulous rash and a typical black spot or inoculation canker. Diagnosis was done by a positive Weil-Félix test. The treatment used was tetracycline with good results. Incidence of this disease is increasing in our country.

We would like to mention the difficulty in establishing a diagnosis of brucellosis without the help of the laboratory owing to the polymorphous of its symptomatology and its very variable evolution. Quoted are the different parameters used in the Development Laboratory "Dr. Ruiz Castañeda', such as the blue drop, fixation on surface, agglutination on plate, agglutination in tube, intradermal reaction and haemoculture, utilizing each of these in the moment it becomes positive, and its correlation with the state of suffering involved which permits us to catalogue the brucellosis as: acute, chronic and relapse brucellar. It determines also the significance that this classification has in the therapeutic management of the patient, and its evolution.

This study consists on an eight week completely randomized investigator blind trial designed to compare the relative efficacy and tolerance of clindamycin phosphate topical solution and tetracycline in the treatment of patients with mild to moderate acne vulgaris. Patients were seen at baseline, weeks 2, 4, 6 and 8. Of the forty-five case report forms received in house, thirty-four are considered to be evaluable. Seven patients failed the entry criteria, two patients were lost to follow-up and two patients left due to lack of tolerance to the medication. All patients receiving medication were examined for both local and global tolerance indices. Within group analyses show significant improvement for both medication groups with respect to the continuous efficacy parameters: inflammatory lesions, pustules, papules and comedo counts. After adjusting for initial baseline differences, no differences between the two groups arose for these variables. The investigating physician on the average judged clindamycin phosphate to be significantly more efficacious than tetracycline trends for the patients evaluation supported these results. Throughout the study, the incidence of peeling, erythema and itching was low and similar for both groups. Two tetracycline patients did however terminate participation in the study due to itching. Significantly more patients receiving tetracycline complained of a burning sensation. No diarrhea or other side effects were recorded.

A 66 year old woman with a history suggesting a tick bite on the right arm developed a slowly expanding erythematosus lesion. Similar lesions appeared on the trunk and extremities in the following months. A skin biopsy showing spiral shaped agents and the clinical findings were compatible with erythema chronicum migrans. A course of penicillin resulted in complete resolution of the lesions. After a 2 year follow up period she remains free of rheumatic, neurologic or cardiac lesions of Lyme's disease.

Authors present a prospective study of 130 cases of Mediterranean spotted fever treated between 1983 and 1985 in two Departments of Paediatrics of the Valles Occidental, area near Barcelona. Thirty-eight percent of the children came from suburban areas, an urban areas, an urban or rural origin being less frequent. Previous contacts with dogs existed in 86% of the cases. Most frequent clinical signs were fever (100%) maculo-papular rash (97%) and arthromyalgias (70%). The "tache noire" was found in 87% of the cases. Presence of arthritis in two patients is underlined. Indirect immunofluorescence to Rickettsia conorii was positive (much greater than 1/40) in 75% of the cases. All patients improved after treatment with tetracycline or erythromycin. There were no relapse.

Forty-three patients with recurrent malignant pleural effusions were included in a prospective protocol of treatment with two different types of tetracycline. Twenty-one patients (series A) were treated with a saline dilution of oxytetracycline (pH = 8) and twenty-two (series B) with a saline dilution of tetracycline chlorhydrate (pH = 2). Among the patients of series A, the rate of no recurrence of the effusion was 85.7% (12 out of 14 correctly treated and followed-up patients). In the series B, the rate of no recurrence was 86.6% (13 out of 15). The authors conclude that the pH of the tetracycline is not a determinant of pleural symphysis. The mechanism of action of the intrapleural tetracycline is discussed.