Tratamiento de la tuberculosis: Guía práctica elaborada por la Sección Tuberculosis, Asociación Argentina de Medicina Respiratoria

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Abstract

La tuberculosis es una enfermedad prevalente en todo el mundo. La emergencia de cepas multirresistentes del Mycobacterium tuberculosis ha incentivado la búsqueda de nuevos fármacos. Existen diversas guías de tratamiento de la enfermedad, internacionales y a nivel programático local. Un grupo de especialistas argentinos elaboró una guía práctica basada en criterios clínicos y en la bibliografía nacional e internacional sobre el tema a través de reuniones de consenso, abarcando tópicos como: fármacos antituberculosos disponibles en la Argentina, modalidades de tratamiento inicial y retratamiento, tratamiento en situaciones especiales, reacciones adversas a fármacos antituberculosos, indicaciones actuales de tratamiento quirúrgico y nuevos fármacos en estudio para el tratamiento de la enfermedad.

Translated abstract

Tuberculosis is a worldwide prevalent disease. The emergence of multidrug-resistant strains spurred the search for new drugs. There are several tuberculosis treatment guidelines, international and local in a programmatic approach. An Argentinean specialists panel draw practical guidelines based in clinical criteria and the local and international bibliography through consensus meetings, including issues as: antituberculosis drugs available in Argentina, initial and re-treatement modalities, special situations treatment, adverse reactions to antituberculosis drugs, current indications of surgical treatment and new drugs under study for the treatment of the disease.

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Outpatient gatifloxacin therapy and dysglycemia in older adults.

David Juurlink, Therese A Stukel, Kunal Shah … (2006)

Gatifloxacin has been associated with both hypoglycemia and hyperglycemia. We examined dysglycemia-related health outcomes associated with various antibiotics in a population of approximately 1.4 million Ontario, Canada, residents 66 years of age or older. We conducted two population-based, nested case-control studies. In the first, case patients were persons treated in the hospital for hypoglycemia after outpatient treatment with a macrolide, a second-generation cephalosporin, or a respiratory fluoroquinolone (gatifloxacin, levofloxacin, moxifloxacin, or ciprofloxacin). In the second, case patients were persons who received hospital care for hyperglycemia. For each case patient, we identified up to five controls matched according to age, sex, the presence or absence of diabetes, and the timing of antibiotic therapy. Between April 2002 and March 2004, we identified 788 patients treated for hypoglycemia within 30 days after antibiotic therapy. As compared with macrolide antibiotics, gatifloxacin was associated with an increased risk of hypoglycemia (adjusted odds ratio, 4.3; 95 percent confidence interval, 2.9 to 6.3). Levofloxacin was also associated with a slightly increased risk (adjusted odds ratio, 1.5; 95 percent confidence interval, 1.2 to 2.0), but no such risk was seen with moxifloxacin, ciprofloxacin, or cephalosporins. We then identified 470 patients treated for hyperglycemia within 30 days after antibiotic therapy. As compared with macrolides, gatifloxacin was associated with a considerably increased risk of hyperglycemia (adjusted odds ratio, 16.7; 95 percent confidence interval, 10.4 to 26.8), but no risk was noted with the other antibiotics. Risks were similar in the two studies regardless of the presence or absence of diabetes. As compared with the use of other broad-spectrum oral antibiotics, including other fluoroquinolones, the use of gatifloxacin among outpatients is associated with an increased risk of in-hospital treatment for both hypoglycemia and hyperglycemia. Copyright 2006 Massachusetts Medical Society.