Fracaso del tratamiento y efectos adversos después de la administración de amoxicilina-clavulanato frente a la
Timothy J Savage1,2,3, Matthew P Kronman4, Sushama Kattinakere Sreedhara1
1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA
|September 18, 2023
Resumen
Amoxicilina-clavulanato y amoxicilina muestran un éxito similar en el tratamiento de la sinusitis aguda infantil. Sin embargo, el amoxicilina-clavulanato aumenta los riesgos de problemas gastrointestinales e infecciones por hongos en pacientes pediátricos.
Área de la Ciencia:
- Enfermedades infecciosas pediátricas
- Farmacología clínica
- Medicina basada en la evidencia
Sus antecedentes:
- La sinusitis aguda es una razón frecuente para la prescripción de antibióticos en niños.
- La selección óptima de antibióticos empíricos para la sinusitis aguda carece de consenso.
Objetivo del estudio:
- Comparar la eficacia y la seguridad de la amoxicilina-clavulanato frente a la amoxicilina para el tratamiento de la sinusitis aguda en niños ambulatorios.
Principales métodos:
- Un estudio de cohorte retrospectivo utilizó una base de datos nacional de atención médica.
- Se incluyeron niños y adolescentes (≤ 17 años) con diagnóstico de sinusitis aguda.
- Para el control de los factores de confusión se empleó la comparación de la puntuación de propensión.
Principales resultados:
- No se observaron diferencias significativas en las tasas de fracaso del tratamiento entre amoxicilina-clavulanato y amoxicilina.
- El amoxicilina-clavulanato se asoció con un mayor riesgo de síntomas gastrointestinales e infecciones por hongos.
- El análisis estratificado por edad no indicó diferencias en el fracaso del tratamiento, pero aumentó el riesgo de eventos adversos con amoxicilina-clavulanato en niños más pequeños.
Conclusiones:
- Para la sinusitis aguda pediátrica ambulatoria, el amoxicilina-clavulanato no ofrece una tasa de fracaso del tratamiento superior en comparación con la amoxicilina.
- El uso de amoxicilina-clavulanato en niños está relacionado con una mayor incidencia de trastornos gastrointestinales e infecciones secundarias por levaduras.
- Los hallazgos apoyan la selección de antibióticos con conocimiento de causa para la sinusitis aguda, teniendo en cuenta tanto la eficacia como los posibles efectos adversos.
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