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Article ; Online: Chapter 8: Fungal infections in immunocompromised patients.

Silva, Rodney Frare e

Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia

2009 Volume 36, Issue 1, Page(s) 142–147

Abstract: Pulmonary complications are the most common cause of morbidity and mortality in immunocompromised patients, who lack of the basic mechanisms of cellular defense. Regardless of the cause of the immunodeficiency, the most common complications are ... ...

Abstract	Pulmonary complications are the most common cause of morbidity and mortality in immunocompromised patients, who lack of the basic mechanisms of cellular defense. Regardless of the cause of the immunodeficiency, the most common complications are infections (bacterial, viral or fungal). Among the fungal infections, aspergillosis is the most common (incidence, 1-9%; mortality, 55-92%) following organ transplant. Although pulmonary involvement is the most common form of aspergillosis, central nervous system involvement and sinusitis are not uncommon. On CT scans, the halo sign represents an area of low attenuation around the nodule, revealing edema or hemorrhage. The gold standard for the diagnosis is the culture identification of the fungus in sputum, BAL fluid or biopsy samples. Failing this identification, the detection of galactomannan, which is one of the fungal wall components, has shown sensitivity and specificity of 89% and 98%, respectively. Amphotericin B, liposomal amphotericin B, caspofungin and, especially, voriconazole are effective against the fungus. Although Pneumocystis jirovecii pneumonia can be fatal, the incidence of this disease has decreased due to the prophylactic use of trimethoprim-sulfamethoxazole. In immunocompromised patients presenting with dyspnea and hypoxemia, screening for fungi is indicated. A 14- to 21-day course of trimethoprim-sulfamethoxazole in combination with corticosteroids is usually efficacious. Another rare fungal infection is disseminated candidiasis, which is caused by Candida spp.
MeSH term(s)	Antifungal Agents/therapeutic use ; Candida albicans ; Humans ; Immunocompromised Host ; Pneumocystis carinii ; Pulmonary Aspergillosis/drug therapy ; Pulmonary Aspergillosis/immunology ; Pulmonary Aspergillosis/microbiology ; Pulmonary Aspergillosis/pathology
Chemical Substances	Antifungal Agents
Language	Portuguese
Publishing date	2009-03-07
Publishing country	Brazil
Document type	Journal Article ; Review
ZDB-ID	2223157-2
ISSN	1806-3756 ; 1806-3713
ISSN (online)	1806-3756
ISSN	1806-3713
DOI	10.1590/s1806-37132010000100019
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Capítulo 8 - Infecções fúngicas em imunocomprometidos Chapter 8 - Fungal infections in immunocompromised patients

Rodney Frare e Silva

Jornal Brasileiro de Pneumologia, Vol 36, Iss 1, Pp 142-

2010 Volume 147

Abstract: As complicações pulmonares se constituem na maior causa de morbidade e mortalidade no hospedeiro ... infecções bacterianas, virais e fúngicas são as mais frequentes. Entre as infecções fúngicas, a aspergilose ... é a mais comum (incidência de 1-9% e mortalidade de 55-92%) nos diferentes tipos de transplantados ...

Abstract	As complicações pulmonares se constituem na maior causa de morbidade e mortalidade no hospedeiro imunocomprometido, devido à deficiência nos mecanismos básicos de defesa. Independente da causa da imunodepressão, infecções bacterianas, virais e fúngicas são as mais frequentes. Entre as infecções fúngicas, a aspergilose é a mais comum (incidência de 1-9% e mortalidade de 55-92%) nos diferentes tipos de transplantados. Embora a forma pneumônica seja a mais frequente, lesões do sistema nervoso central e sinusite não são raras. O sinal do halo em TC de tórax representa uma área de baixa atenuação em volta do nódulo, revelando edema ou hemorragia. O padrão ouro para o diagnóstico é a identificação do fungo por cultura de escarro, amostras de LBA ou biópsia. Na falta dessa identificação, a detecção de galactomanana, um dos componentes da parede celular de Aspergillus sp., tem mostrado sensibilidade e especificidade de 89% e 98%, respectivamente. Anfotericina B, anfotericina B lipossomal, caspofungina e voriconazol têm efeito sobre o fungo, com destaque para esse último. A pneumonia por Pneumocystis jirovecii, que pode ser fatal, teve sua incidência reduzida pelo uso preventivo de sulfametoxazol/trimetoprima. Dispneia e hipoxemia em pacientes imunodeprimidos indicam a necessidade da pesquisa de fungos. O uso de sulfametoxazol/trimetoprima por 14-21 dias associado com corticosteroides costuma ser eficaz. A candidíase disseminada é outra rara enfermidade fúngica causada por Candida spp. Pulmonary complications are the most common cause of morbidity and mortality in immunocompromised patients, who lack of the basic mechanisms of cellular defense. Regardless of the cause of the immunodeficiency, the most common complications are infections (bacterial, viral or fungal). Among the fungal infections, aspergillosis is the most common (incidence, 1-9%; mortality, 55-92%) following organ transplant. Although pulmonary involvement is the most common form of aspergillosis, central nervous system involvement and sinusitis are not uncommon. On CT scans, the halo sign represents an area of low attenuation around the nodule, revealing edema or hemorrhage. The gold standard for the diagnosis is the culture identification of the fungus in sputum, BAL fluid or biopsy samples. Failing this identification, the detection of galactomannan, which is one of the fungal wall components, has shown sensitivity and specificity of 89% and 98%, respectively. Amphotericin B, liposomal amphotericin B, caspofungin and, especially, voriconazole are effective against the fungus. Although Pneumocystis jirovecii pneumonia can be fatal, the incidence of this disease has decreased due to the prophylactic use of trimethoprim-sulfamethoxazole. In immunocompromised patients presenting with dyspnea and hypoxemia, screening for fungi is indicated. A 14- to 21-day course of trimethoprim-sulfamethoxazole in combination with corticosteroids is usually efficacious. Another rare fungal infection is disseminated candidiasis, which is caused by Candida spp.
Keywords	Pneumonia ; Imunossupressão ; Pneumopatias fúngicas ; Immunosuppression ; Lung diseases ; fungal ; Diseases of the respiratory system ; RC705-779 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Internal medicine ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	Portuguese
Publishing date	2010-02-01T00:00:00Z
Publisher	Sociedade Brasileira de Pneumologia e Tisiologia
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Carcinomatous lymphangitis as the initial manifestation of ovarian adenocarcinoma.

Martynychen, Mariane Gonçalves / Rabelo, Lêda Maria / Silva, Rodney Luiz Frare E / Escuissato, Dante Luiz

Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia

2007 Volume 33, Issue 5, Page(s) 609–611

Abstract: Carcinomatous lymphangitis accounts for approximately 8% of all cases of metastatic pulmonary tumors. The most common primary sites are breast, lung, stomach, prostate and pancreas. We describe herein the case of a 42-year-old woman in whom the first ... ...

Abstract	Carcinomatous lymphangitis accounts for approximately 8% of all cases of metastatic pulmonary tumors. The most common primary sites are breast, lung, stomach, prostate and pancreas. We describe herein the case of a 42-year-old woman in whom the first manifestation of an ovarian adenocarcinoma was carcinomatous lymphangitis of the lung, an unusual presentation of the disease.
MeSH term(s)	Adenocarcinoma/pathology ; Adenocarcinoma/secondary ; Adult ; Biopsy ; Bronchoscopy ; Female ; Humans ; Lung Neoplasms/complications ; Lung Neoplasms/diagnosis ; Lymphangitis/complications ; Lymphangitis/diagnosis ; Ovarian Neoplasms/pathology ; Ovarian Neoplasms/secondary ; Tomography, X-Ray Computed ; Ultrasonography ; Vagina/diagnostic imaging
Language	Portuguese
Publishing date	2007-10-30
Publishing country	Brazil
Document type	Case Reports ; Journal Article
ZDB-ID	2223157-2
ISSN	1806-3756 ; 1806-3713
ISSN (online)	1806-3756
ISSN	1806-3713
DOI	10.1590/s1806-37132007000500018
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Article ; Online: Linfangite carcinomatosa pulmonar como manifestação inicial de adenocarcinoma de ovário Carcinomatous lymphangitis as the initial manifestation of ovarian adenocarcinoma

Mariane Gonçalves Martynychen / Lêda Maria Rabelo / Rodney Luiz Frare e Silva / Dante Luiz Escuissato

Jornal Brasileiro de Pneumologia, Vol 33, Iss 5, Pp 609-

2007 Volume 611

Abstract: ... sítios primários mais comuns são mama, pulmão, estômago, próstata e pâncreas. Descrevemos o caso de uma ...

Abstract	A linfangite carcinomatosa corresponde a cerca de 8% das neoplasias pulmonares metastáticas. Os sítios primários mais comuns são mama, pulmão, estômago, próstata e pâncreas. Descrevemos o caso de uma paciente de 42 anos na qual a primeira manifestação de um adenocarcinoma de ovário foi a linfangite carcinomatosa, uma forma incomum de apresentação da doença. Carcinomatous lymphangitis accounts for approximately 8% of all cases of metastatic pulmonary tumors. The most common primary sites are breast, lung, stomach, prostate and pancreas. We describe herein the case of a 42-year-old woman in whom the first manifestation of an ovarian adenocarcinoma was carcinomatous lymphangitis of the lung, an unusual presentation of the disease.
Keywords	Linfangite ; Neoplasias pulmonares ; Neoplasias ovarianas ; Metástase linfática ; Hipertensão pulmonar ; Lymphangitis ; Lung neoplasms ; Ovarian neoplasms ; Lymphatic metastasis ; Hypertension ; pulmonary ; Diseases of the respiratory system ; RC705-779 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Internal medicine ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	Portuguese
Publishing date	2007-10-01T00:00:00Z
Publisher	Sociedade Brasileira de Pneumologia e Tisiologia
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Comparison between azithromycin and amoxicillin in the treatment of infectious exacerbation of chronic obstructive pulmonary disease.

Andre-Alves, Mara Rúbia / Jardim, José Roberto / Frare e Silva, Rodney / Fiss, Elie / Freire, Denison Noronha / Teixeira, Paulo José Zimermann

Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia

2007 Volume 33, Issue 1, Page(s) 43–50

Abstract: Objective: To compare the efficacy, safety, and tolerability of azithromycin and amoxicillin in the treatment of patients with infectious exacerbation of chronic obstructive pulmonary disease.: Methods: This study was conducted at six medical centers ...

Abstract	Objective: To compare the efficacy, safety, and tolerability of azithromycin and amoxicillin in the treatment of patients with infectious exacerbation of chronic obstructive pulmonary disease. Methods: This study was conducted at six medical centers across Brazil and included 109 patients from 33 to 82 years of age. Of those, 102 were randomized to receive either azithromycin (500 mg/day for three days, n = 49) or amoxicillin (500 mg every eight hours for ten days, n = 53). The patients were evaluated at the study outset, on day ten, and at one month. Based on the clinical evaluation of the signs and symptoms present on day ten and at one month, the outcomes were classified as cure, improvement, or treatment failure. The microbiological evaluation was made through the culture of sputum samples that were considered appropriate samples only after leukocyte counts and Gram staining. Secondary efficacy evaluations were made in order to analyze symptoms (cough, dyspnea, and expectoration) and pulmonary function. Results: There were no differences between the groups treated with azithromycin or amoxicillin in terms of the percentages of cases in which the outcomes were classified as cure or improvement: 85% vs. 78% (p = 0.368) on day ten; and 83% vs. 78% (p = 0.571) at one month. Similarly, there were no significant differences between the two groups in the secondary efficacy variables or the incidence of adverse effects. Conclusion: Azithromycin and amoxicillin present similar efficacy and tolerability in the treatment of acute exacerbation of chronic obstructive pulmonary disease.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Ambulatory Care ; Amoxicillin/therapeutic use ; Analysis of Variance ; Anti-Bacterial Agents/therapeutic use ; Azithromycin/therapeutic use ; Female ; Gram-Negative Bacteria/isolation & purification ; Gram-Positive Cocci/isolation & purification ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive/drug therapy ; Pulmonary Disease, Chronic Obstructive/microbiology ; Treatment Outcome
Chemical Substances	Anti-Bacterial Agents ; Amoxicillin (804826J2HU) ; Azithromycin (83905-01-5)
Language	Portuguese
Publishing date	2007-06-11
Publishing country	Brazil
Document type	Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	2223157-2
ISSN	1806-3756 ; 1806-3713
ISSN (online)	1806-3756
ISSN	1806-3713
DOI	10.1590/s1806-37132007000100010
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Smoking cessation among patients at a university hospital in Curitiba, Brazil.

Silva, Rodney Luiz Frare e / Carmes, Eliane Ribeiro / Schwartz, Alain Felipe / Blaszkowski, Denise de Souza / Cirino, Raphael Henrique Déa / Ducci, Renata Dal-Prá

Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia

2011 Volume 37, Issue 4, Page(s) 480–487

Abstract: Objective: To determine the prevalence of smoking and the frequency of smoking cessation counseling among patients at a university hospital, as well as to compare smokers and former smokers in terms of smoking history.: Methods: A cross-sectional ... ...

Abstract	Objective: To determine the prevalence of smoking and the frequency of smoking cessation counseling among patients at a university hospital, as well as to compare smokers and former smokers in terms of smoking history. Methods: A cross-sectional study involving 629 patients at the Federal University of Paraná Hospital de Clínicas, located in the city of Curitiba, Brazil. Results: Of the 629 patients, 206 (32.7%) were male, 76 (12.1%) were smokers, 179 (28.5%) were former smokers, and 374 (59.5%) were nonsmokers. The mean age of the patients was 49.9 ± 15.0 years (range, 18-84 years). Of the 76 smokers and 179 former smokers, 72 (94.7%) and 166 (92.7%), respectively, were questioned about tobacco use. Smoking history and degree of nicotine dependence were higher among the former smokers (p = 0.0292 and p = 0.0125, respectively). Gender, age at smoking initiation, physician inquiry about tobacco use, and smoking cessation counseling were comparable between the two groups. The smoking cessation rate was 0.70. The prevalence of heavy smoking varied by gender and by age bracket, being higher in males and in the 41-70 year age bracket. Conclusions: The smoking prevalence in this group of patients was lower than that reported for patients at another university hospital, for adults in Curitiba, and for adults in Brazil. The smoking cessation rate was higher in these patients than in the general population of Curitiba. Smokers and former smokers differed regarding age, smoking history, and degree of nicotine dependence. Heavy smoking and a moderate or high degree of nicotine dependence were not obstacles to smoking cessation.
MeSH term(s)	Adolescent ; Adult ; Age Distribution ; Age Factors ; Aged ; Brazil/epidemiology ; Counseling/statistics & numerical data ; Cross-Sectional Studies ; Female ; Hospitals, University/statistics & numerical data ; Humans ; Male ; Middle Aged ; Prevalence ; Sex Distribution ; Sex Factors ; Smoking/epidemiology ; Smoking Cessation/psychology ; Smoking Cessation/statistics & numerical data ; Young Adult
Language	Portuguese
Publishing date	2011-11-01
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	2223157-2
ISSN	1806-3756 ; 1806-3713
ISSN (online)	1806-3756
ISSN	1806-3713
DOI	10.1590/s1806-37132011000400010
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: High-resolution CT findings of respiratory syncytial virus pneumonia after bone marrow transplantation.

Gasparetto, Emerson L / Escuissato, Dante L / Marchiori, Edson / Ono, Sérgio / Frare e Silva, Rodney L / Müller, Nestor L

AJR. American journal of roentgenology

2004 Volume 182, Issue 5, Page(s) 1133–1137

Abstract: Objective: The aim of this study was to describe the high-resolution CT findings of respiratory syncytial virus pneumonia in 20 patients who had undergone allogeneic bone marrow transplantation.: Materials and methods: The study included 20 ... ...

Abstract	Objective: The aim of this study was to describe the high-resolution CT findings of respiratory syncytial virus pneumonia in 20 patients who had undergone allogeneic bone marrow transplantation. Materials and methods: The study included 20 consecutive patients who developed respiratory syncytial virus pneumonia after bone marrow transplantation and who had high-resolution CT of the chest performed within 24 hr after the onset of symptoms. The CT scans were reviewed by two chest radiologists who assessed the pattern and distribution of findings. Results: Bone marrow transplantation was performed on 12 male and eight female patients ranging from 3 to 48 years old (mean age, 25 years) for treatment of various forms of leukemia (n = 12), severe aplastic anemia (n = 6), Fanconi's syndrome (n = 1), and paroxysmal nocturnal hemoglobinuria (n = 1). Sixteen patients (80%) had abnormal CT findings. The predominant patterns of abnormality on high-resolution CT scans were small centrilobular nodules (10/20, 50%), air-space consolidation (7/20, 35%), ground-glass opacities (6/20, 30%), and bronchial wall thickening (6/20, 30%). The abnormalities were distributed in the central and peripheral areas of the lungs in nine cases, only in the periphery in five cases, and only in the central regions in two cases. The abnormalities were bilateral and asymmetric in distribution in 13 patients, bilateral and symmetric in two patients, and unilateral in one patient. Conclusion: The most common high-resolution CT findings in patients with respiratory syncytial virus pneumonia after bone marrow transplantation consist of small centrilobular nodules and multifocal areas of consolidation and ground-glass opacities in a bilateral asymmetric distribution.
MeSH term(s)	Adolescent ; Adult ; Bone Marrow Transplantation/adverse effects ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Pneumonia, Viral/diagnostic imaging ; Pneumonia, Viral/etiology ; Respiratory Syncytial Virus Infections/diagnostic imaging ; Respiratory Syncytial Virus Infections/etiology ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2004-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	82076-3
ISSN	1546-3141 ; 0361-803X ; 0092-5381
ISSN (online)	1546-3141
ISSN	0361-803X ; 0092-5381
DOI	10.2214/ajr.182.5.1821133
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Article ; Online: Cessação de tabagismo em pacientes de um hospital universitário em Curitiba Smoking cessation among patients at a university hospital in Curitiba, Brazil

Rodney Luiz Frare e Silva / Eliane Ribeiro Carmes / Alain Felipe Schwartz / Denise de Souza Blaszkowski / Raphael Henrique Déa Cirino / Renata Dal-Prá Ducci

Jornal Brasileiro de Pneumologia, Vol 37, Iss 4, Pp 480-

2011 Volume 487

Abstract: OBJETIVO: Determinar a prevalência de tabagismo e do aconselhamento para a cessação do tabagismo em ... fumantes e ex-fumantes. MÉTODOS: Estudo transversal com 629 pacientes do Hospital de Clínicas da ... masculino, 76 (12,1%) eram fumantes, 179 (28,5%) eram ex-fumantes, e 374 (59,5%) eram não fumantes. A média ...

Abstract	OBJETIVO: Determinar a prevalência de tabagismo e do aconselhamento para a cessação do tabagismo em um grupo de pacientes de um hospital universitário, assim como comparar a carga tabágica entre fumantes e ex-fumantes. MÉTODOS: Estudo transversal com 629 pacientes do Hospital de Clínicas da Universidade Federal do Paraná, localizado em Curitiba. RESULTADOS: Dos 629 pacientes, 206 (32,7%) eram do sexo masculino, 76 (12,1%) eram fumantes, 179 (28,5%) eram ex-fumantes, e 374 (59,5%) eram não fumantes. A média de idade dos pacientes foi de 49,9 ± 15,0 anos (variação: 18-84 anos). Dos 76 fumantes e 179 ex-fumantes, 72 (94,7%) e 166 (92,7%), respectivamente, foram indagados sobre o hábito de fumar. A carga tabágica e o grau de dependência de nicotina foram maiores entre os ex-fumantes (p = 0,0292 e p = 0,0125, respectivamente). Gênero, idade ao início do tabagismo, questionamento médico sobre hábito de fumar e orientação para cessação do fumo foram semelhantes entre os dois grupos. O índice de cessação de tabagismo foi de 0,70. A prevalência de fumo pesado variou entre os gêneros e as faixas etárias - maior entre os homens e na faixa etária de 41-70 anos. CONCLUSÕES: A prevalência de tabagismo neste grupo de pacientes foi menor do que a observada em pacientes de outro hospital universitário e na população adulta de Curitiba e do Brasil. O índice de cessação do tabagismo foi maior do que o da população de Curitiba. Fumantes e ex-fumantes diferiram em relação à idade, à carga tabágica e ao grau de dependência. Fumo pesado e dependência média ou elevada não impediram cessação do tabagismo. OBJECTIVE: To determine the prevalence of smoking and the frequency of smoking cessation counseling among patients at a university hospital, as well as to compare smokers and former smokers in terms of smoking history. METHODS: A cross-sectional study involving 629 patients at the Federal University of Paraná Hospital de Clínicas, located in the city of Curitiba, Brazil. RESULTS: Of the 629 patients, 206 (32.7%) were male, 76 (12.1%) were smokers, 179 (28.5%) were former smokers, and 374 (59.5%) were nonsmokers. The mean age of the patients was 49.9 ± 15.0 years (range, 18-84 years). Of the 76 smokers and 179 former smokers, 72 (94.7%) and 166 (92.7%), respectively, were questioned about tobacco use. Smoking history and degree of nicotine dependence were higher among the former smokers (p = 0.0292 and p = 0.0125, respectively). Gender, age at smoking initiation, physician inquiry about tobacco use, and smoking cessation counseling were comparable between the two groups. The smoking cessation rate was 0.70. The prevalence of heavy smoking varied by gender and by age bracket, being higher in males and in the 41-70 year age bracket. CONCLUSIONS: The smoking prevalence in this group of patients was lower than that reported for patients at another university hospital, for adults in Curitiba, and for adults in Brazil. The smoking cessation rate was higher in these patients than in the general population of Curitiba. Smokers and former smokers differed regarding age, smoking history, and degree of nicotine dependence. Heavy smoking and a moderate or high degree of nicotine dependence were not obstacles to smoking cessation.
Keywords	Tabagismo ; Abandono do hábito de fumar ; Hospitalização ; Smoking ; Smoking cessation ; Hospitalization ; Diseases of the respiratory system ; RC705-779 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Internal medicine ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	Portuguese
Publishing date	2011-08-01T00:00:00Z
Publisher	Sociedade Brasileira de Pneumologia e Tisiologia
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Comparação entre a azitromicina e a amoxicilina no tratamento da exacerbação infecciosa da doença pulmonar obstrutiva crônica Comparison between azithromycin and amoxicillin in the treatment of infectious exacerbation of chronic obstructive pulmonary disease

Mara Rúbia Andre-Alves / José Roberto Jardim / Rodney Frare e Silva / Elie Fiss / Denison Noronha Freire / Paulo José Zimermann Teixeira

Jornal Brasileiro de Pneumologia, Vol 33, Iss 1, Pp 43-

2007 Volume 50

Abstract: OBJETIVO: Comparar a eficácia, segurança e tolerabilidade da azitromicina e da amoxicilina no ... MÉTODOS: Seis centros brasileiros incluíram 109 pacientes com idades entre 33 e 82 anos. Desses pacientes ... dez dias e depois de um mês. A avaliação clínica, de acordo com os sinais e sintomas presentes após ...

Abstract	OBJETIVO: Comparar a eficácia, segurança e tolerabilidade da azitromicina e da amoxicilina no tratamento de pacientes com quadro clínico de exacerbação infecciosa da doença pulmonar obstrutiva crônica. MÉTODOS: Seis centros brasileiros incluíram 109 pacientes com idades entre 33 e 82 anos. Desses pacientes, 102 foram randomizados para receber azitromicina (500 mg por dia por três dias, n = 49) ou amoxicilina (500 mg a cada oito horas por dez dias, n = 53). Os pacientes foram avaliados no início do estudo, após dez dias e depois de um mês. A avaliação clínica, de acordo com os sinais e sintomas presentes após dez dias e após um mês, consistiu na classificação dos casos nas categorias cura, melhora ou falha terapêutica. A avaliação microbiológica foi feita pela cultura de amostras de escarro consideradas adequadas após contagem de leucócitos e coloração de Gram. Avaliações secundárias de eficácia foram feitas com relação aos sintomas (tosse, dispnéia e expectoração) e à função pulmonar. RESULTADOS: Não houve diferenças entre as proporções de casos classificados como cura ou melhora entre os grupos tratados com a azitromicina ou a amoxicilina. Essas proporções foram, respectivamente, de 85% vs. 78% (p = 0,368) após dez dias, e de 83% vs. 78% (p = 0,571) após um mês. Também não foram encontradas diferenças significativas entre os dois grupos quando comparadas as variáveis secundárias de eficácia e a incidência de eventos adversos. CONCLUSÃO: A azitromicina tem eficácia e tolerabilidade semelhantes às da amoxicilina para o tratamento da exacerbação aguda da Doença pulmonar obstrutiva crônica. OBJECTIVE: To compare the efficacy, safety, and tolerability of azithromycin and amoxicillin in the treatment of patients with infectious exacerbation of chronic obstructive pulmonary disease. METHODS: This study was conducted at six medical centers across Brazil and included 109 patients from 33 to 82 years of age. Of those, 102 were randomized to receive either azithromycin (500 mg/day for three days, n = 49) or amoxicillin (500 mg every eight hours for ten days, n = 53). The patients were evaluated at the study outset, on day ten, and at one month. Based on the clinical evaluation of the signs and symptoms present on day ten and at one month, the outcomes were classified as cure, improvement, or treatment failure. The microbiological evaluation was made through the culture of sputum samples that were considered appropriate samples only after leukocyte counts and Gram staining. Secondary efficacy evaluations were made in order to analyze symptoms (cough, dyspnea, and expectoration) and pulmonary function. RESULTS: There were no differences between the groups treated with azithromycin or amoxicillin in terms of the percentages of cases in which the outcomes were classified as cure or improvement: 85% vs. 78% (p = 0.368) on day ten; and 83% vs. 78% (p = 0.571) at one month. Similarly, there were no significant differences between the two groups in the secondary efficacy variables or the incidence of adverse effects. CONCLUSION: Azithromycin and amoxicillin present similar efficacy and tolerability in the treatment of acute exacerbation of chronic obstructive pulmonary disease.
Keywords	Amoxicilina ; Azitromicina ; Bronquite crônica ; Doença pulmonar obstrutiva crônica ; Estudo comparativo ; Amoxicillin ; Azithromycin ; Bronchitis ; chronic ; Pulmonary disease ; chronic obstructive ; Comparative study ; Diseases of the respiratory system ; RC705-779 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Internal medicine ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	Portuguese
Publishing date	2007-02-01T00:00:00Z
Publisher	Sociedade Brasileira de Pneumologia e Tisiologia
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Brazilian guidelines for community-acquired pneumonia in immunocompetent adults - 2009.

Corrêa, Ricardo de Amorim / Lundgren, Fernando Luiz Cavalcanti / Pereira-Silva, Jorge Luiz / Frare e Silva, Rodney Luiz / Cardoso, Alexandre Pinto / Lemos, Antônio Carlos Moreira / Rossi, Flávia / Michel, Gustavo / Ribeiro, Liany / Cavalcanti, Manuela Araújo de Nóbrega / de Figueiredo, Mara Rúbia Fernandes / Holanda, Marcelo Alcântara / Valery, Maria Inês Bueno de André / Aidê, Miguel Abidon / Chatkin, Moema Nudilemon / Messeder, Octávio / Teixeira, Paulo José Zimermann / Martins, Ricardo Luiz de Melo / da Rocha, Rosali Teixeira

Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia

2009 Volume 35, Issue 6, Page(s) 574–601

Abstract: Community-acquired pneumonia continues to be the acute infectious disease that has the greatest medical and social impact regarding morbidity and treatment costs. Children and the elderly are more susceptible to severe complications, thereby justifying ... ...

Abstract	Community-acquired pneumonia continues to be the acute infectious disease that has the greatest medical and social impact regarding morbidity and treatment costs. Children and the elderly are more susceptible to severe complications, thereby justifying the fact that the prevention measures adopted have focused on these age brackets. Despite the advances in the knowledge of etiology and physiopathology, as well as the improvement in preliminary clinical and therapeutic methods, various questions merit further investigation. This is due to the clinical, social, demographical and structural diversity, which cannot be fully predicted. Consequently, guidelines are published in order to compile the most recent knowledge in a systematic way and to promote the rational use of that knowledge in medical practice. Therefore, guidelines are not a rigid set of rules that must be followed, but first and foremost a tool to be used in a critical way, bearing in mind the variability of biological and human responses within their individual and social contexts. This document represents the conclusion of a detailed discussion among the members of the Scientific Board and Respiratory Infection Committee of the Brazilian Thoracic Association. The objective of the work group was to present relevant topics in order to update the previous guidelines. We attempted to avoid the repetition of consensual concepts. The principal objective of creating this document was to present a compilation of the recent advances published in the literature and, consequently, to contribute to improving the quality of the medical care provided to immunocompetent adult patients with community-acquired pneumonia.
MeSH term(s)	Adult ; Brazil ; Community-Acquired Infections/diagnosis ; Community-Acquired Infections/drug therapy ; Community-Acquired Infections/prevention & control ; Humans ; Immunocompetence ; Pneumonia, Bacterial/diagnosis ; Pneumonia, Bacterial/drug therapy ; Pneumonia, Bacterial/prevention & control ; Severity of Illness Index
Language	Portuguese
Publishing date	2009-07-16
Publishing country	Brazil
Document type	Journal Article ; Practice Guideline
ZDB-ID	2223157-2
ISSN	1806-3756 ; 1806-3713
ISSN (online)	1806-3756
ISSN	1806-3713
DOI	10.1590/s1806-37132009000600011
Database	MEDical Literature Analysis and Retrieval System OnLINE

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