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Vol. 39. Núm. 6.
Páginas 274-282 (Junio 2003)
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Vol. 39. Núm. 6.
Páginas 274-282 (Junio 2003)
DOI: 10.1016/S0300-2896(03)75380-0
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Segundo documento de consenso sobre uso de antimicrobianos en la exacerbación de la enfermedad pulmonar obstructiva crónica
Second consensus report on the use of antimicrobial agents in exacerbations of chronic obstructive pulmonary disease
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...
F. Álvareza, E. Bouzab, J.A. García-Rodríguezb,??
Autor para correspondencia
jagarrod@gugu.usal.es

Correspondencia: Departamento de Microbiología. Hospital Universitario. P.° San Vicente 108. 37007 Salamanca. España
, J. Mensab, E. Monsóa, J.J. Picazob, V. Sobradilloa, A. Torresa, M. Moya Mirc, M. Martínez Ortiz de Záratec, F. Pérez Escanillad, T. Puentee, J.L. Cañadae
a Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
b Sociedad Española de Quimioterapia (Seq)
c Sociedad Española de Medicina de Urgencias y Emergencias (Semes)
d Sociedad Española de Medicina General (Semg)
e Sociedad Española de Medicina Rural y Generalista (Semergen)
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En el año 2000, expertos de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), la Sociedad Española de Quimioterapia (SEQ) y la Sociedad Española de Medicina Familiar y Comunitaria (SEMFyC), conscientes de la importancia de la enfermedad pulmonar obstructiva crónica (EPOC), elaboraron un documento-consenso que pudiera servir como base para el control de la enfermedad, mediante un adecuado uso de antimicrobianos. Ahora, 3 años después, y con motivo de importantes avances científicos, se plantea una profunda revisión, que en realidad constituye el Segundo Documento de Consenso sobre Uso de antimicrobianos en la exacerbación de la enfermedad pulmonar obstructiva crónica. Por un lado, diferentes sociedades científicas han demostrado interés en adherirse al proyecto y trabajar en él: Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), Sociedad Española de Medicina General (SEMG) y Sociedad Española de Medicina Rural y Generalista (SEMERGEN), lo cual, conjuntamente con la declinación de la SEMFyC, obliga a cambiar la estructura y algunos contenidos del documento. Por otra parte, en el momento presente se ha incorporado al arsenal terapéutico del médico un nuevo grupo de antimicrobianos (los cetólidos) con un único representante hasta ahora, la telitromicina, que permite considerarlo no sólo como terapia alternativa sino de elección, incluso en determinadas circunstancias clínicas que se analizan en el documento. Éstos son los dos aspectos más significativos que, sumados a otros, como la cada vez más aceptada actividad de levofloxacino sobre Pseudomonas aeruginosa y la constante actividad que demuestra amoxicilina-ácido clavulánico cuando se administra a las dosis recomendadas cada 8 horas, ofrecen nuevos patrones antibióticos para el tratamiento de esta enfermedad. Por último, se analizan científicamente otros grupos de antimicrobianos (macrólidos, cefalosporinas orales, etc.) y se ofrecen normas de empleo de estos agentes, tanto por parte de los especialistas como de los médicos de atención primaria

Aware of the importance of chronic obstructive pulmonary disease (COPD), a panel of experts belonging to the Spanish Society of Respiratory Medicine and Thoracic Surgery (SEPAR), the Spanish Society of Chemotherapy (SEQ) and the Spanish Society of Family and Community Medicine (SEMFyC) issued a statement of consensus in 2000 to serve as the basis for adequate antibiotic control of the disease. Three years later, in accordance with significant scientific progress made in this area, the statement has been thoroughly revised. The new paper in fact constitutes a second consensus statement on the use of antibiotics in COPD exacerbations. When several scientific associations expressed interest in joining the project and contributing to it –the Spanish Society of Emergency Medicine (SEMES), the Spanish Society of General Medicine (SEMG) and the Spanish Society of Rural and General Medicine (SEMERGEN)– their incorporation led SEPAR and SEMFyC to change the structure of the statement and certain aspects of its content. Additionally, a new group of antibiotics, the ketolides, has joined the therapeutic arsenal. Telithromycin, the single representative of the group for the moment, can be considered not only an alternative treatment but even the drug of choice in certain clinical settings that are analyzed in the new statement. Those developments, along with others, such as the increasingly recognized action of levofloxacin against Pseudomonas aeruginosa and the steady action of amoxicillin with clavulanic acid when administered at recommended doses every 8 hours, provide new antimicrobial therapeutic protocols for COPD. Finally, the statement includes a scientific analysis of other groups of antimicrobial agents (macrolides, oral cephalosporins, etc.) and guidelines for both primary care physicians and specialists to follow when prescribing them

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