Con base en la síntesis de los datos disponibles a partir de estudios clínicos controlados es posible afirmar que el rango de curación o éxito clínico en el manejo de la faringitis causada por EBHGA se encuentra entre 93% y 100%, con excepción de un estudio con resultados discordantes (Pacífico y colaboradores) en el que se informa la tasa más baja, de 75%.
Vale la pena resaltarla frecuencia de éxito clínico general es similar a la observada con los antimicrobianos usados como comparación, que en la mayoría de los casos es penicilina V. La tasa de erradicación del EBHGA luego del tratamiento ha variado entre valores de 57% y 98%. Hay una clara relación entre la dosis diaria de azitromicina y la respuesta bacteriológica, de forma tal que los valores superiores de eficacia bacteriológica se asocian con la administración de 20 mg/kg del macrólido.
Si se toma en cuenta que los objetivos antes descritos para el tratamiento incluyen la erradicación bacteriana, la prevención de las complicaciones supurativas y no supurativas, la curación clínica rápida, la seguridad para el paciente, la rápida reincorporación a las actividades diarias y la promoción de la adherencia, disminuyendo la posibilidad de incumplimiento y abandono, cualquiera de los regímenes de dosificación de azitromicina (10 o 20 mg/kg/día durante tres días) puede cumplir estos objetivos. El principal objetivo que es la erradicación del EBHGA con el tratamiento de la faringitis estreptocócica, como medida para disminuir la recurrencia y el desarrollo de complicaciones de la enfermedad, se cumple mejor con la dosis de 20 mg/kg/día.
Conclusiones
De acuerdo con la evidencia de investigación disponible, azitromicina es segura y efectiva en el tratamiento de la faringoamigdalitis estreptocócica en niños. Con los datos actuales es posible recomendar el esquema de manejo por tres días con azitromicina, en dosis de 10 o 20 mg/kg en una sola toma diaria, durante tres días, como una opción para el tratamiento de la faringoamigdalitis estreptocócica en niños.
Summary
Objective: To evaluate the role of azithromycin in the treatment of Streptococcal Pharyngitis.
Source of Information: Medline data base, Research Pharmaceutical Companies, Communication with experts.
Selection of the Studies: Controlled clinical studies in which azithromycin in dosage of 10 and/or 20mg administered by three days is compared with one or more antimicrobials for the treatment of Streptococcal Pharyngitis, with evaluation of clinical and microbiological effectiveness and safety.
Synthesis of the Data: Azithromycin was compared in five studies against Penicillin V, in one with Cefaclor and in other one with Erythromycin. The results show a rate of clinical success between 94% and 100%, similar or superior to obtained with Penicillin V. The rate of eradication of the Group A ß-hemolytic streptococci with Azithromycin in 20 mg/kg doses is between 94% and 98%, similar or superior to antimicrobial comparators, in which the rate of eradication was between 82% and 95%. With the 10 mg/kg doses of azithromycin this rate range between 58% and 98%. The azithromycin safety is similart o the other antimicrobial comparators. The therapy withdrawal rate due to adverse events is as low as 4% with azithromycin and 2% with erythromycin.
Conclusion: Azithromycin is saf e and effective in the treatment of the Streptococcal Pharyngitis in children. With the present data it is possible to recommend that the azithromycin dosing regimen of 10 or 20 mg/kg given once daily for three days can be included as an option for the treatment of pediatrics treptococcal pharyngitis.
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Correspondencia. Manuel Chaves
Av. El Dorado No. 68B-85 Piso 5. Bogotá, Colombia
