Amoxicillin for insect bites

The effectiveness of the antibiotics was compared in patients with radiologically proven pneumonia compared to those without pneumonia for all three outcomes. Cox regression was used for the duration of symptoms allowing for censoring, simple linear regression for symptom severity and logistic regression for worsening of illness. Interaction

terms

A total of 2055 patients with acute cough were recruited in the randomised controlled trial (RCT), of which 1905 (93%) underwent a chest radiograph.

Patients with a chest radiograph of insufficient quality (n=20) were excluded, resulting in 1885 subjects for analysis. Patients without chest radiograph results were younger and had a higher baseline symptom severity. The mean± sd age of the 1885 subjects was 49 ± 16 years and 41% (n=769) were male. Radiologically proven pneumonia was present in 56 (3%) out of 1885.

Baseline characteristics did not differ significantly between those with and without pneumonia nor in patients with pneumonia between those allocated to amoxicillin (n=23) and to those allocated to placebo (n=33). Patients with radiologically proven pneumonia who were allocated to antibiotics had faster resolution of symptoms rated “moderately bad or worse” than those allocated to placebo (median 5 days versus 11 days, HR 2.20, 95% CI 1.18–4.08, p=0.013; interaction term for the difference in effect between those with and without pneumonia amoxicillin 500mg chest infection 2.04, p=0.024) and lower mean (95% CI) symptom severity on days 2–4 were ?0.68 (?1.28– ?0.08) (p=0.027), although the interaction term was of borderline significance (interaction term ?0.63; p=0.050) (table 1). Development of new or worsening symptoms was not different in those allocated to antibiotics as compared to those allocated to placebo (OR 0.33, 95% CI 0.10–1.11; p=0.074) and the effect of antibiotics between those with and without pneumonia was not different (interaction term 0.38; p=0.125).

In patients

with

Two patients in the placebo group and one in the amoxicillin group needed to be admitted to hospital. Prognostic outcomes for radiologically proven pneumonia in amoxicillin versus placebo group compared to those without pneumonia. Our findings are consistent with recommendations in current guidelines [1, 2] that those with radiologically proven pneumonia appear to derive beneficial effect from antibiotics on symptom duration and symptom severity. The findings from our placebo-controlled study will compliment trials of head to head comparisons between antibiotic classes summarised in the Cochrane review of antibiotics for pneumonia in

primary

In this analysis only patients with clinically unsuspected pneumonia were studied that represent likely the somewhat milder end of the clinical spectrum. In these patients we saw a clear and relevant effect of antibiotics. In addition, power calculation of the original RCT did not include this subgroup analysis of patients with pneumonia, which is another reason why we could have missed some true effects of the intervention.

Finally, stratifying all trial patients according to the presence or absence of radiologically proven pneumonia makes it uncertain whether confounders were still randomly distributed between these two groups.

However, baseline characteristics did not differ significantly between those allocated to amoxicillin and those allocated to placebo in this subgroup.

Radiologically proven pneumonia which is not clinically suspected at presentation does benefit from antibiotic treatment in terms of symptom duration and symptom severity.

This suggests that efforts to detect even the milder and less clear cases of pneumonia in primary care are worthwhile.

Since it is not feasible or cost-effective to perform a chest radiograph in all patients with signs and symptoms of a LRTI in primary care, diagnostic models and the use of point-of-care tests could be useful in improving diagnostic strategies in these patients. Contributors: Chris Butler, Samuel Coenen, Herman Goossens, Kerenza

Hood

Jolien Teepe, Nori Elshof, Lidewij Broekhuizen and Beth Stuart interpreted data and performed the analyses.

Jolien Teepe,

Nori

mentioned

The clinical part of the GRACE consortium consists of: Jolien Teepe (Netherlands), Lidewij Broekhuizen (Netherlands), Curt Brugman (Netherlands), Chris Butler (UK), Kerenza Hood (UK), Samuel Coenen (Belgium), Herman Goossens (Belgium), Margareta Ieven (Belgium), Christine Lammens (Belgium), Jordi Almirall (Spain), Francesco Blasi (Italy),

Slawomir

We would like to thank the entire GRACE team for their diligence, expertise and enthusiasm. We are indebted to all of the patients who consented to be part of GRACE, without whom this study would not have been possible. TRIPLE THERAPY WITH CLARITHROMYCIN, AMOXICILLIN AND OMEPRAZOLE FOR Helicobacter pylori ERADICATION IN CHILDREN AND ADOLESCENTS.

Elisabete KAWAKAMI* , Silvio Kazuo OGATA** , Aurea C.

PATRICIO**** ABSTRACT ? Background ? Helicobacter pylori infection presents high prevalence in developing countries, but there are few pediatric assays evaluating antimicrobial treatment. Objective - The aim of this study was to investigate Helicobacter pylori eradication rate using a short regimen (7 and 10 days) of triple therapy with clarithromycin, amoxicillin and omeprazole. Patients and methods - Twenty-five Hp positive patients who presented severe epigastralgia, were submitted to antimicrobial treatment with amoxicillin (50 mg/kg/day - maximum dose 1g bid), clarithromycin (30 mg/kg/day - maximum dose 500 mg bid) and omeprazole (0.6 mg/kg/day - maximum dose 20 mg bid) during 7 or 10 days. After 2 months, clinical

symptoms

Results - Overall eradication rate was achieved in 16/25 patients (64% - IC(95%) = 45-83%), in 11/15 (73% - IC(95%) = 51-95%) patients who used 10 days therapy course and in 5/10 (50% - IC(95%) = 19-81%) who used 7 days therapy course. Eradication drugs were well accepted and adverse effects were reported in two patients (8%). Conclusions - This triple therapy regimen had moderate efficacy (64%).

The data suggests that 10 days therapy course

achieves

A meta-analysis of a large number of controlled studies indicated that the presence of Hp gastritis in the absence of peptic ulcer may be a risk factor in non-ulcer dyspepsia (odds ratio 1.6, IC(95%) = 1.4-1.8) and symptoms improve when the organism is successfully eradicated (1.9, IC(95%) = 1.3-2.6) (10) .

In children a positive correlation between Hp gastritis without peptic ulcer and dyspeptic symptoms or recurrent abdominal pain (17) has not been well established (8, 14, 22) .

Two pediatric consensus on Hp infection recommended not to treat all Hp positive children with recurrent abdominal pain (6, 28) .

In dyspeptic children of developing countries, we could overtreat these children due to the high prevalence of Hp infection.

Recently, refractory iron deficiency anemia that respond to the Hp eradication have been described (3, 16) . Current treatment protocols suggest triple therapy as first line therapy, proton pump inhibitor plus two antibiotics (amoxycillin,

clarithromycin

Clinical assays have shown proton pump inhibitors in combination with clarithromycin and amoxicillin (CAO) to be effective in clinical trials with eradication rate in more

than

In children, the same treatment has presented similar rate although rate of 75% has been obtained (26, 29) .

Advantages of this therapy, widely used in adult patients, involves the exclusion of nitroimidazole, that presented high bacterial resistance, ranging from 40% to 98% (2, 18) with higher prevalence in developing countries (18, 24) . The aim of this study was to evaluate the Hp eradication rate following 7-days and 10-days CAO course in treatment of Hp associated gastritis with or without primary peptic ulcer in children.