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Guía para el diagnóstico y tratamiento de pacientes que refieren alergia a betalactámicos

Silvio Espínola, Pedro Piraino, Perla Alcaraz, Dory Mora, y colaboradores

ARCHIVOS DE ALERGIA E INMUNOLOGÍA CLÍNICA ;():0095-0116 

Antecedentes. Paraguay (OPS/OMS) muestra que la prevalencia de la sífilis en embarazadas presenta valores elevados que no han descendido en los últimos diez años. En el 2018, se estimó 3,0% de prevalencia de sífilis, el tratamiento con penicilina benzatínica es la cura, pero como un gran porcentaje de médicos pide prueba de sensibilidad antes de su administración el tratamiento es cuantitativamente insuficiente.
Objetivo. Con el objetivo de unificar el manejo de pacientes que refieren alergia a betalactámicos, para médicos especialistas en Alergia y no especialistas y puntualizar normativas que permitan pragmatismo, hemos elaborado esta guía.
Método. Conforme a la metodología ADAPTE, se usó AGREE II después de la búsqueda bibliográfica sobre manejo de pacientes que requieren tratamiento con betalactámicos publicadas entre 1969 -2018. Se fusionó la realidad local con la evidencia de las mejores publicaciones. El documento inicial fue sometido a la revisión de representantes de 8 sociedades médicas hasta llegar a la versión final de la Guía.
Resultado. Después de 3 rondas Delphi se desarrolló un documento en el que se consideraron las características de los pacientes según edad, métodos de diagnóstico, costos de los tratamientos, reacciones cruzadas y perfiles de seguridad de los betalactámicos.
Conclusión. Con la cooperación de neumonólogos, infectólogos, internistas, pediatras, médicos de familia y emergentólogos se llegó a un consenso basado en evidencia, en el que se incluyeron recomendaciones sobre prevención, diagnóstico y tratamiento de pacientes que refieren alergia a betalactámicos.


Palabras clave: betalactámicos, hipersensibilidad, cadenas laterales, pruebas cutáneas, algoritmo, alternativos, desensibilización,

Background. Paraguay (PAHO/WHO) shows that the pregnant women syphilis prevalence presents high values that have not decreased in the last ten years. In 2018, a 3.0% of syphilis prevalence was estimated. Treatment with benzathine penicillin is the cure, but since a large percentage of physicians’ request sensitivity testing before administration the treatment is quantitatively insufficient.
Objective. We have prepared this Guide for allergy specialists and non-specialists to unify the management of patients with ß-lactams allergies, and to specify regulations that achieve pragmatism.
Methods. AGREE II was used according to the ADAPTE methodology after bibliographic searching articles published between 1969 - 2018 about the require ß-lactams treatment patients management. The local reality was merged with the best publications evidence. The initial document was reviewed by 8 medical societies representatives until reached the Guide final version.
Results. After 3 Delphi rounds, a document was established in which patients’ characteristics were considered according to age, ß-lactams diagnostic methods, treatment costs, cross-reactions, and safety profiles.
Conclusion. With the cooperation of lung specialists, infectious disease specialists, internal medicine specialists, pediatricians, family doctors and emergency physicians an evidence-based consensus was reached including recommendations on prevention, diagnosis and treatment of patients who refer allergy to ß-lactams.


Keywords: ß-lactams, hypersensitivity, side chains, skin tests, algorithm, alternatives, desensitization,

Los autores declaran no poseer conflictos de intereses.

Fuente de información Asociación Argentina de Alergia e Inmunología Clínica. Para solicitudes de reimpresión a Archivos de Alergia e Inmunología Clínica hacer click aquí.

Recibido 2019-10-31 | Aceptado 2020-07-31 | Publicado 2020-12-31

Figura 1. Cronología de reacciones de hipersensibilidad a ß– lactámicos.

Tabla 1. Signos de peligro/gravedad y diagnóstico,

Figura 2. Reacciones alérgicas inmediatas a fármacos (mediadas y no mediadas por IgE). Posibles si...

Tabla 2. Reacciones alérgicas inmediatas a fármacos (mediadas y no mediadas por IgE). Posibles si...

Tabla 3. Cefalosporinas y penicilinas con idénticas cadenas laterales

Tabla 4. Guía para la toma de decisiones.:

Figura 3. Algoritmo 1. Para médicos no alergólogos.

Figura 4. Algoritmo 2. Para alergólogos. PPCP: prueba de provocación controlada y progresiva o tes...

Tabla 5. Concentraciones de prueba no irritantes para antibióticos betalactámicos.

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Autores
Silvio Espínola
Médico alergólogo.
Pedro Piraino
Médico alergólogo.
Perla Alcaraz
Médico alergólogo.
Dory Mora
Médico alergólogo.
y colaboradores
Guía validada por la Sociedad Paraguaya de Alergia, Asma e Inmunología.

Autor correspondencia
Silvio Espínola
Médico alergólogo.

Correo electrónico: silmatom@hotmail.com

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Etiquetas

 betalactámicos, hipersensibilidad, cadenas laterales, pruebas cutáneas, algoritmo, alternativos, desensibilización,

Tags

 ß-lactams, hypersensitivity, side chains, skin tests, algorithm, alternatives, desensitization,

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Titulo
Guía para el diagnóstico y tratamiento de pacientes que refieren alergia a betalactámicos

Autores
Silvio Espínola, Pedro Piraino, Perla Alcaraz, Dory Mora, y colaboradores

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Archivos de Alergia e Inmunología Clínica

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Asociación Argentina de Alergia e Inmunología Clínica

Fecha de publicación
2020-12-31

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