Unidad de Farmacia (MM). Establecimiento donde se realizó el estudio: Hospital Clínico Regional d... more Unidad de Farmacia (MM). Establecimiento donde se realizó el estudio: Hospital Clínico Regional de Concepción Dr. Guillermo Grant Benavente. Declaración de conflictos de intereses: Sergio Mella Montecinos declara recibir el pago de honorarios por conferencias de Merck Sharp & Dohme (MSD) y el apoyo para viajes por parte de Astra Zeneca y MSD. El resto de los autores declara no presentar conflictos de intereses.
n engl j med 372;6 nejm.org february 5, 2015 581 imbalance can complicate treatment of alcohol wi... more n engl j med 372;6 nejm.org february 5, 2015 581 imbalance can complicate treatment of alcohol withdrawal in persons receiving high rates of infusion of lorazepam, especially in the context of renal dysfunction. This is noteworthy for any clinician treating critically ill patients who require intravenous sedatives. Finucane cites a 1988 article that emphasized that the risk of grand mal convulsions increases with higher quantities of alcohol consumed and that alcohol-related seizures can be observed in the absence of obvious withdrawal symptoms. This is an important reminder of the central role that heavy drinking plays in seizure risk and underscores the need for clinicians to consider heavy alcohol intake in the differential diagnosis of convulsions, even in the absence of an alcohol withdrawal syndrome. Finally, Armon’s letter is consistent with the conclusion that the treatment of alcohol withdrawal syndromes can include any brain-depressant drug, including alcohol. However, it may be a bit more difficult to establish the appropriate dose of alcohol, as compared with other sedative-hypnotic agents. For mild withdrawal, alcohol may be associated with greater respiratory depression and potentially more intoxicationrelated aggression than benzodiazepines.
The quinolones are one of the most developed group of antibiotic agents. They have a heteroaromat... more The quinolones are one of the most developed group of antibiotic agents. They have a heteroaromatic bicyclic structure constituted by a pyridone βcarboxylic acid nucleus and an aromatic ring. The relation between the chemical structure and biological activity (structure-activity relation) of these molecules has motivated the synthesis of compounds with different radicals in the basic chemical structure. Position 1: the most important substitute is the cyclopropyl group that combines favorable spatial and electronic interacting properties, being the quinolones that posses this group very active on gram negative bacilli. Other important substitutes that have been developed, are mono or bi fluorinated benzene rings, that amplify the spectrum of activity and better the pharmacokinetic properties, but could be associated to toxicity. The position 2, 3 and 4 have not significantly varied. The position 6, because of the presence of fluor, practically defines the modern quinolones, nevertheless there have been quinolones with interesting in vitro activity that have been synthesized, which lack fluor. In position 5, the presence of some amino o methyl groups favor some pharmacokinetic properties. In position 8, the presence of some halogens increase the antianaerobic activity, in particular C1 and F, but this is associated to phototoxicity which incentives the synthesis of compounds without halogens. These molecules are classified in generations according to the moment in which they have been synthesized and to the radicals used.
The aim of this study was analyze the use of restricted antibiotics by patients hospitalized betw... more The aim of this study was analyze the use of restricted antibiotics by patients hospitalized between 2004 and 2008 in Guillermo Grant Benavente Hospital in Concepcion. Also we attempted to identify possible correlations between antibiotic consumption and patterns of bacterial susceptibility. We performed a retrospective observational study that quantified the use of restricted antibiotics using DDD/100-bed-days, and cumulative susceptibility reports informed by the hospital's microbiology laboratory for bacterial susceptibility. The consumption of restricted antibiotics significantly increased between 2004 and 2008 (35%, p = 0.005). The groups with largest use were glycopeptides (37%) and carbapenems (30 %). These results can be explained by the emergence of endemic Methicillin-resistant Staphylococcus aureus (MRSA) and of Extended-spectrum beta-lactamase (ESBL) Gram negative bacilli. Results showed a decrease in susceptibility of P. aeruginosa to imipenem (p = 0.038) and K. pneumoniae to ciprofloxacin (p = 0.021). The total consumption of restricted antibiotic has significantly increased, especially among complex medical services. A significant decrease in bacterial susceptibility has been observed mainly in gram-negative bacilli. The monitoring of antimicrobial prescribing practices and local susceptibility patterns are essential to promote the rational use of antibiotics.
Unidad de Farmacia (MM). Establecimiento donde se realizó el estudio: Hospital Clínico Regional d... more Unidad de Farmacia (MM). Establecimiento donde se realizó el estudio: Hospital Clínico Regional de Concepción Dr. Guillermo Grant Benavente. Declaración de conflictos de intereses: Sergio Mella Montecinos declara recibir el pago de honorarios por conferencias de Merck Sharp & Dohme (MSD) y el apoyo para viajes por parte de Astra Zeneca y MSD. El resto de los autores declara no presentar conflictos de intereses.
n engl j med 372;6 nejm.org february 5, 2015 581 imbalance can complicate treatment of alcohol wi... more n engl j med 372;6 nejm.org february 5, 2015 581 imbalance can complicate treatment of alcohol withdrawal in persons receiving high rates of infusion of lorazepam, especially in the context of renal dysfunction. This is noteworthy for any clinician treating critically ill patients who require intravenous sedatives. Finucane cites a 1988 article that emphasized that the risk of grand mal convulsions increases with higher quantities of alcohol consumed and that alcohol-related seizures can be observed in the absence of obvious withdrawal symptoms. This is an important reminder of the central role that heavy drinking plays in seizure risk and underscores the need for clinicians to consider heavy alcohol intake in the differential diagnosis of convulsions, even in the absence of an alcohol withdrawal syndrome. Finally, Armon’s letter is consistent with the conclusion that the treatment of alcohol withdrawal syndromes can include any brain-depressant drug, including alcohol. However, it may be a bit more difficult to establish the appropriate dose of alcohol, as compared with other sedative-hypnotic agents. For mild withdrawal, alcohol may be associated with greater respiratory depression and potentially more intoxicationrelated aggression than benzodiazepines.
The quinolones are one of the most developed group of antibiotic agents. They have a heteroaromat... more The quinolones are one of the most developed group of antibiotic agents. They have a heteroaromatic bicyclic structure constituted by a pyridone βcarboxylic acid nucleus and an aromatic ring. The relation between the chemical structure and biological activity (structure-activity relation) of these molecules has motivated the synthesis of compounds with different radicals in the basic chemical structure. Position 1: the most important substitute is the cyclopropyl group that combines favorable spatial and electronic interacting properties, being the quinolones that posses this group very active on gram negative bacilli. Other important substitutes that have been developed, are mono or bi fluorinated benzene rings, that amplify the spectrum of activity and better the pharmacokinetic properties, but could be associated to toxicity. The position 2, 3 and 4 have not significantly varied. The position 6, because of the presence of fluor, practically defines the modern quinolones, nevertheless there have been quinolones with interesting in vitro activity that have been synthesized, which lack fluor. In position 5, the presence of some amino o methyl groups favor some pharmacokinetic properties. In position 8, the presence of some halogens increase the antianaerobic activity, in particular C1 and F, but this is associated to phototoxicity which incentives the synthesis of compounds without halogens. These molecules are classified in generations according to the moment in which they have been synthesized and to the radicals used.
The aim of this study was analyze the use of restricted antibiotics by patients hospitalized betw... more The aim of this study was analyze the use of restricted antibiotics by patients hospitalized between 2004 and 2008 in Guillermo Grant Benavente Hospital in Concepcion. Also we attempted to identify possible correlations between antibiotic consumption and patterns of bacterial susceptibility. We performed a retrospective observational study that quantified the use of restricted antibiotics using DDD/100-bed-days, and cumulative susceptibility reports informed by the hospital's microbiology laboratory for bacterial susceptibility. The consumption of restricted antibiotics significantly increased between 2004 and 2008 (35%, p = 0.005). The groups with largest use were glycopeptides (37%) and carbapenems (30 %). These results can be explained by the emergence of endemic Methicillin-resistant Staphylococcus aureus (MRSA) and of Extended-spectrum beta-lactamase (ESBL) Gram negative bacilli. Results showed a decrease in susceptibility of P. aeruginosa to imipenem (p = 0.038) and K. pneumoniae to ciprofloxacin (p = 0.021). The total consumption of restricted antibiotic has significantly increased, especially among complex medical services. A significant decrease in bacterial susceptibility has been observed mainly in gram-negative bacilli. The monitoring of antimicrobial prescribing practices and local susceptibility patterns are essential to promote the rational use of antibiotics.
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