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ABSTRACT Background Several therapies have been used or proposed for the treatment of COVID-19, although their effectiveness and safety have not been properly evaluated. The purpose of this document is to provide recommendations to support decisions about the drug treatment of outpatients with COVID-19 in Brazil. Methods A panel consisting of experts from different clinical fields, representatives of the Brazilian Ministry of Health, and methodologists (37 members in total) was responsible for preparing these guidelines. A rapid guideline development method was used, based on the adoption and/or adaptation of recommendations from existing international guidelines combined with additional structured searches for primary studies and new recommendations whenever necessary (GRADE-ADOLOPMENT). The rating of quality of evidence and the drafting of recommendations followed the GRADE method. Results Ten technologies were evaluated, and 10 recommendations were prepared. Recommendations were made against the use of anticoagulants, azithromycin, budesonide, colchicine, corticosteroids, hydroxychloroquine/chloroquine alone or combined with azithromycin, ivermectin, nitazoxanide, and convalescent plasma. It was not possible to make a recommendation regarding the use of monoclonal antibodies in outpatients, as their benefit is uncertain and their cost is high, with limitations of availability and implementation. Conclusion To date, few therapies have demonstrated effectiveness in the treatment of outpatients with COVID-19. Recommendations are restricted to what should not be used, in order to provide the best treatment according to the principles of evidence-based medicine and to promote resource savings by aboiding ineffective treatments.

https://doi.org/10.1016/j.bjid.2022.102347

One year after the arrival of COVID-19 in Latin America: what have we learned in Brazil and other countries?
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Cimerman, Sergio

; Chebabo, Alberto

; Cunha, Clovis Arns da

; Rodríguez-Morales, Alfonso J.

Brazilian Journal of Infectious Diseases

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2021, Volume 25 N. 2 elocation 101571

Abstract: En | Text: En | PDF: En

https://doi.org/10.1016/j.bjid.2021.101571 87 downloads

Brazilian Society of Hepatology and Brazilian Society of Infectious Diseases Guidelines for the Diagnosis and Treatment of Hepatitis B
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Ferraz, Maria Lucia

; Strauss, Edna

; Perez, Renata Mello

; Schiavon, Leonardo

; Ono, Suzane Kioko

; Pessoa, Mario Guimarães

; Ferreira, Adalgisa Paiva

; Nabuco, Leticia

; Carvalho-Filho, Roberto

; Tovo, Cristiane

; Souto, Francisco

; Abrão, Paulo

; Reuter, Tania

; Dantas, Thor

; Vigani, Aline

; Porta, Gilda

; Ferreira, Marcelo Simão

; Paraná, Raymundo

; Cimerman, Sergio

; Bittencourt, Paulo Lisboa

Brazilian Journal of Infectious Diseases

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oct 2020, Volume 24 N. 5 Pages 434 - 451

Abstract: En | Text: En | PDF: En

Abstract Chronic hepatitis B is an important health problem that can progress to cirrhosis and complications such as hepatocellular carcinoma. There is approximately 290 million of people with chronic hepatitis B virus (HBV) infection worldwide, however only 10% of patients are currently identified.Most part of Brazil is considered of low prevalence of HBV infection but there are some regions with higher frequency of carriers. Unfortunately, many infected patients are not yet identified nor evaluated for treatment.The Brazilian Society of Infectious Diseases (SBI) and the Brazilian Society of Hepatology worked together to elaborate a guideline for diagnosis and treatment of hepatitis B. The document includes information regarding the population to be tested, diagnostic tools, indications of treatment, therapeutic schemes and also how to handle HBV infection in specific situations (pregnancy, children, immunosuppression, etc).Delta infection is also part of the guideline, since it is an important infection in some parts of the country.

https://doi.org/10.1016/j.bjid.2020.07.012 744 downloads

After the pandemic: the role of science in the future of the countries
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Palacios, Ricardo

; Covas, Dimas Tadeu

; Pereira Júnior, Luiz Carlos

; Cimerman, Sergio

Brazilian Journal of Infectious Diseases

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jun 2020, Volume 24 N. 3 Pages 189 - 190

Abstract: En | Text: En | PDF: En

https://doi.org/10.1016/j.bjid.2020.06.006 207 downloads

Diretrizes para o tratamento farmacológico da COVID-19. Consenso da Associação de Medicina Intensiva Brasileira, da Sociedade Brasileira de Infectologia e da Sociedade Brasileira de Pneumologia e Tisiologia
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Falavigna, Maicon

; Colpani, Verônica

; Stein, Cinara

; Azevedo, Luciano Cesar Pontes

; Bagattini, Angela Maria

; Brito, Gabriela Vilela de

; Chatkin, José Miguel

; Cimerman, Sergio

; Corradi, Mirian de Freitas Dal Ben

; Cunha, Clovis Arns da

; Medeiros, Flávia Cordeiro de

; Oliveira Junior, Haliton Alves de

; Fritscher, Leandro Genehr

; Gazzana, Marcelo Basso

; Gräf, Débora Dalmas

; Marra, Lays Pires

; Matuoka, Jessica Yumi

; Nunes, Michelle Silva

; Pachito, Daniela Vianna

; Pagano, Cássia Garcia Moraes

; Parreira, Patrícia do Carmo Silva

; Riera, Rachel

; Silva Júnior, Amilton

; Tavares, Bruno de Melo

; Zavascki, Alexandre Prehn

; Rosa, Regis Goulart

; Dal-Pizzol, Felipe

Revista Brasileira de Terapia Intensiva

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jun 2020, Volume 32 N. 2 Pages 166 - 196

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Introdução: Há diversas terapias sendo utilizadas, consideradas ou propostas para o tratamento da COVID-19, muitas carecendo de apropriada avaliação de efetividade e segurança. O propósito deste documento é fornecer recomendações baseadas nas evidências científicas disponíveis e em sua interpretação transparente, para subsidiar decisões sobre o tratamento farmacológico da COVID-19 no Brasil. Métodos: Um grupo de 27 especialistas e metodologistas integraram a força-tarefa formada pela Associação de Medicina Intensiva Brasileira (AMIB), pela Sociedade Brasileira de Infectologia (SBI) e pela Sociedade Brasileira de Pneumologia e Tisiologia (SBPT). Foram realizadas revisões sistemáticas rápidas, atualizadas até 28 de abril de 2020. A qualidade das evidências e a elaboração das recomendações seguiram o sistema GRADE. As recomendações foram elaboradas nos dias 5, 8 e 13 de maio de 2020. Resultados: Foram geradas 11 recomendações, embasadas em evidência de nível baixo ou muito baixo. Não há indicação para uso de rotina de hidroxicloroquina, cloroquina, azitromicina, lopinavir/ritonavir, corticosteroides ou tocilizumabe no tratamento da COVID-19. Heparina deve ser utilizada em doses profiláticas no paciente hospitalizado, mas não deve ser realizada anticoagulação na ausência de indicação clínica específica. Antibacterianos e oseltamivir devem ser considerados somente nos pacientes em suspeita de coinfecção bacteriana ou por influenza, respectivamente. Conclusão: Até o momento, não há intervenções farmacológicas com efetividade e segurança comprovada que justifiquem seu uso de rotina no tratamento da COVID-19, devendo os pacientes serem tratados preferencialmente no contexto de pesquisa clínica. As recomendações serão revisadas continuamente, de forma a capturar a geração de novas evidências.

ABSTRACT Introduction: Different therapies are currently used, considered, or proposed for the treatment of COVID-19; for many of those therapies, no appropriate assessment of effectiveness and safety was performed. This document aims to provide scientifically available evidence-based information in a transparent interpretation, to subsidize decisions related to the pharmacological therapy of COVID-19 in Brazil. Methods: A group of 27 experts and methodologists integrated a task-force formed by professionals from the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB), the Brazilian Society of Infectious Diseases (Sociedad Brasileira de Infectologia - SBI) and the Brazilian Society of Pulmonology and Tisiology (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT). Rapid systematic reviews, updated on April 28, 2020, were conducted. The assessment of the quality of evidence and the development of recommendations followed the GRADE system. The recommendations were written on May 5, 8, and 13, 2020. Results: Eleven recommendations were issued based on low or very-low level evidence. We do not recommend the routine use of hydroxychloroquine, chloroquine, azithromycin, lopinavir/ritonavir, corticosteroids, or tocilizumab for the treatment of COVID-19. Prophylactic heparin should be used in hospitalized patients, however, no anticoagulation should be provided for patients without a specific clinical indication. Antibiotics and oseltamivir should only be considered for patients with suspected bacterial or influenza coinfection, respectively. Conclusion: So far no pharmacological intervention was proven effective and safe to warrant its use in the routine treatment of COVID-19 patients; therefore such patients should ideally be treated in the context of clinical trials. The recommendations herein provided will be revised continuously aiming to capture newly generated evidence.

https://doi.org/10.5935/0103-507x.20200039 44293 downloads

Joint report of SBI (Brazilian Society of Infectious Diseases), FEBRASGO (Brazilian Federation of Gynecology and Obstetrics Associations), SBU (Brazilian Society of Urology) and SBPC/ML (Brazilian Society of Clinical Pathology/Laboratory Medicine): recommendations for the clinical management of lower urinary tract infections in pregnant and non-pregnant women
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Rossi, Patricia de

; Cimerman, Sergio

; Truzzi, José Carlos

; Cunha, Clóvis Arns da

; Mattar, Rosiane

; Martino, Marinês Dalla Valle

; Hachul, Maurício

; Andriolo, Adagmar

; Vasconcelos Neto, José Ananias

; Pereira-Correia, João Antônio

; Machado, Antonia M.O.

; Gales, Ana Cristina

Brazilian Journal of Infectious Diseases

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apr 2020, Volume 24 N. 2 Pages 110 - 119

Abstract: En | Text: En | PDF: En

ABSTRACT Urinary tract infection (UTI) is a common condition in women. There is an increased concern on reduction of bacterial susceptibility resulting from wrongly prescribing antimicrobials. This paper summarizes the recommendations of four Brazilian medical societies (SBI - Brazilian Society of Infectious Diseases, FEBRASGO - Brazilian Federation of Gynecology and Obstetrics Associations, SBU - Brazilian Society of Urology, and SBPC/ML - Brazilian Society of Clinical Pathology/Laboratory Medicine) on the management of urinary tract infection in women.Asymptomatic bacteriuria should be screened at least twice during pregnancy (early and in the 3rd trimester). All cases of significant bacteriuria (≥105 CFU/mL in middle stream sample) should be treated with antimicrobials considering safety and susceptibility profile. In women with typical symptoms of cystitis, dipsticks are not necessary for diagnosis. Urine cultures should be collected in pregnant women, recurrent UTI, atypical cases, and if there is suspicion of pyelonephritis. First line antimicrobials for cystitis are fosfomycin trometamol in a single dose and nitrofurantoin, 100 mg every 6 hours for five days. Second line drugs are cefuroxime or amoxicillin-clavulanate for seven days. During pregnancy, amoxicillin and other cephalosporins may be used, but with a higher chance of therapeutic failure.In recurrent UTI, all episodes should be confirmed by urine culture. Treatment should be initiated only after urine sampling and with the same regimens indicated for isolated episodes. Prophylaxis options of recurrent UTI are behavioral measures, non-antimicrobial and antimicrobial prophylaxis. Vaginal estrogens may be recommended for postmenopausal women. Other non-antimicrobial prophylaxis, including cranberry and immunoprophylaxis, have weak evidence supporting their use. Antimicrobial prophylaxis may be offered as a continuous or postcoital scheme. In pregnant women, options are cephalexin, 250-500 mg and nitrofurantoin, 100 mg (contraindicated after 37 weeks of pregnancy). Nonpregnant women may use fosfomycin trometamol, 3 g every 10 days, or nitrofurantoin, 100 mg (continuous or postcoital).

https://doi.org/10.1016/j.bjid.2020.04.002 1294 downloads

Deep impact of COVID-19 in the healthcare of Latin America: the case of Brazil
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Cimerman, Sergio

; Chebabo, Alberto

; Cunha, Clovis Arns da

; Rodríguez-Morales, Alfonso J.

Brazilian Journal of Infectious Diseases

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apr 2020, Volume 24 N. 2 Pages 93 - 95

Abstract: En | Text: En | PDF: En

https://doi.org/10.1016/j.bjid.2020.04.005 1379 downloads

Preparación y control de la enfermedad por coronavirus 2019 (COVID-19) en América Latina
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Rodríguez-Morales, Alfonso J

; Sánchez-Duque, Jorge A

; Hernández Botero, Sebastian

; Pérez-Díaz, Carlos E

; Villamil-Gómez, Wilmer E

; Méndez, Claudio A

; Verbanaz, Sergio

; Cimerman, Sergio

; Rodriguez-Enciso, Hernan D

; Escalera-Antezana, Juan Pablo

; Balbin-Ramon, Graciela J

; Arteaga-Livias, Kovy

; Cvetkovic-Vega, Aleksandar

; Orduna, Tomas

; Savio-Larrea, Eduardo

; Paniz-Mondolfi, Alberto

Acta Médica Peruana

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jan 2020, Volume 37 N. 1 Pages 3 - 7

Abstract: Es | Text: Es | PDF: Es

https://doi.org/10.35663/amp.2020.371.909

10.

Top 10 evidence-based recommendations from the Brazilian Society of Infectious Diseases for the Choosing Wisely Project
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Pasqualotto, Alessandro C.

; Almeida, Camila S.

; Kliemann, Dimas A.

; Barcellos, Guilherme B.

; Queiroz-Telles, Flávio

; Abdala, Edson

; Resende, Mariangela

; Batista, Filipe P.

; Vidal, José E.

; Rocha, Jaime

; Raboni, Sonia M.

; Cimerman, Sergio

; Gales, Ana C.

Brazilian Journal of Infectious Diseases

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oct 2019, Volume 23 N. 5 Pages 331 - 335

Abstract: En | Text: En | PDF: En

ABSTRACT The Choosing Wisely Initiative aims to collect statements from medical societies all over the world on medical interventions that result in no benefit to patients, with the potential to cause harm. In this article we present the views of the Diagnostic Laboratory Group at the Brazilian Society of Infectious Diseases (SBI). Ten experts from SBI were asked to list 10 diagnostic tests that were perceived as unnecessary in the field of infectious diseases. After voting for the more relevant topics, a questionnaire was sent to all SBI members, in order to select for the most important items. A total of 482 votes were obtained, and the top 10 results are shown in this manuscript. The Choosing Wisely statements of SBI should facilitate clinical practice by optimizing the use of diagnostic resources in the field of infectious diseases.

https://doi.org/10.1016/j.bjid.2019.08.004 372 downloads

11.

Recommendations for outpatient parenteral antimicrobial therapy in Brazil
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Oliveira, Priscila R.

; Carvalho, Vladimir C.

; Cimerman, Sergio

; Lima, Ana Lucia Munhoz

Brazilian Journal of Infectious Diseases

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dec 2017, Volume 21 N. 6 Pages 648 - 655

Abstract: En | Text: En | PDF: En

ABSTRACT A panel of national experts was convened by the Brazilian Infectious Diseases Society in order to determine the recommendations for outpatient parenteral antimicrobial therapy (OPAT) in Brazil. The following aspects are covered in the document: organization of OPAT programs; patient evaluation and eligibility criteria, including clinical and sociocultural factors; diagnosis of eligibility; venous access and antimicrobial infusion devices; protocols for antimicrobial use and monitoring and cost-effectiveness.

https://doi.org/10.1016/j.bjid.2017.06.006 1467 downloads

12.

Recommendations for the treatment of osteomyelitis
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Lima, Ana Lucia L.

; Oliveira, Priscila R.

; Carvalho, Vladimir C.

; Cimerman, Sergio

; Savio, Eduardo

Brazilian Journal of Infectious Diseases

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oct 2014, Volume 18 N. 5 Pages 526 - 534

Abstract: En | Text: En | PDF: En

With the advances in surgical treatment, antibiotic therapy and the current resources for accurate diagnosis and differentiated approaches to each type of osteomyelitis, better results are being obtained in the treatment of this disease. After a careful literature review carried out by a multiprofessional team, some conclusions were made in order to guide medical approach to different types of osteomyelitis, aiming to obtain better clinical outcomes and reducing the social costs of this disease. Acute and chronic osteomyelitis are discussed, with presentation of the general epidemiological concepts and the commonly used classification systems. The main guidelines for the clinical, laboratory and imaging diagnosis of infections are discussed, as well as the guidelines for surgical and antimicrobial treatments, and the role of hyperbaric oxygen as adjuvant therapy.

https://doi.org/10.1016/j.bjid.2013.12.005 8841 downloads

13.

Variaciones en las manifestaciones clínicas de la giardiosis en pacientes pediátricos hospitalizados, según grupos de edades
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Almirall, Pedro

; Alfonso, Maydel

; Ávila, Ivonne

; Salazar, Yohana

; Escobedo, Angel A

; Núñez, Fidel A

; Cimerman, Sergio

Revista chilena de infectología

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oct 2013, Volume 30 N. 5 Pages 502 - 506

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

It has been suggested that the clinical features of giardiasis might vary in patients of different age groups. Objective: To compare clinical presentation of giardiasis in children less than 5 years of age and older children. Methods: A retrospective study of patients hospitalized with giardiasis during 2007 was performed. The clinical features of the two age groups were compared. Additionally, length of stay was analyzed. Results: In total, 170 patients were included. In children ≥ 5 years of age, abdominal pain and urticaria were significantly more frequent (OR=9.46; 95%CI: 4.35-20.52,P5=0.000+ and OR=11.0; 95%CI: 1.205-101.11, P=0.023, respectively). Diarrhoea was more frequently found in children younger than 5 years (OR=6.45; IC 95%: 3. 12-13.37, P=0.000+). The frequencies of other symptoms were similar. Length of stay was significantly higher in children under 5 years of age. Discussion and conclusions: Clinical presentations differed in some aspects among the examined age group of our paediatric patients. Our finding might be of importance for an early recognition of giardiasis, which is essential for an accurate diagnosis and a prompt treatment.

La giardiosis es una enfermedad frecuente a escala internacional. Se ha sugerido por algunos autores que su presentación clínica puede variar con la edad. Objetivo: Comparar las manifestaciones clínicas de la giardiosis en los niños hospitalizados bajo 5 años de edad con las de niños de 5 años o más. Métodos: Estudio retrospectivo realizado en el Hospital Pediátrico de Centro Habana durante el año 2007. Las manifestaciones clínicas fueron extraídas utilizando un formulario prediseñado y separadas de acuerdo a los grupos de edades estudiados. Adicionalmente, se extrajo la estadía hospitalaria. Resultados: Se incluyeron 170 pacientes. Los niños de 5 y más años de edad manifestaron con mayor frecuencia dolor abdominal (OR = 9,46; IC 95%: 4,35-20,52, p = 0,000+) y urticaria (OR = 11,0; IC 95%: 1,205-101,11, p = 0,023), mientras que la diarrea se encontró más frecuentemente bajo 5 años de edad (OR = 6,45; IC 95%: 3,12-13,37, p = 0,000+). En el resto de las manifestaciones clínicas no se encontraron diferencias significativas en sus frecuencias entre ambos grupos de edades (p > 0,05). La estadía hospitalaria fue significativamente más prolongada entre los pacientes bajo 5 años de edad. Discusión y conclusiones: Las manifestaciones clínicas pueden variar en algunos aspectos entre los diferentes grupos de edades pediátricas. Su rápido reconocimiento es esencial con el fin de arribar a un diagnóstico preciso y al tratamiento oportuno.

6845 downloads

14.

Detection of Dientamoeba fragilis in patients with HIV/AIDS by using a simplified iron hematoxylin technique
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Garcia, Juliana Alves

; Cimerman, Sergio

Revista da Sociedade Brasileira de Medicina Tropical

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apr 2012, Volume 45 N. 2 Pages 156 - 158

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: Estudos indicam a Dientamoeba fragilis como uma das causas de diarréia em pacientes com HIV/AIDS. MÉTODOS: Os objetivos deste estudo foram avaliar a prevalência de D. fragilis associadas com as causas de diarréia em pacientes com HIV/AIDS internados no Instituto de Infectologia Emílio Ribas (IIER). Oitenta e dois pacientes internados no IIER fizeram parte deste estudo de setembro de 2006 a novembro de 2008. RESULTADOS: No total, 105 amostras foram coletadas a partir de 82 pacientes neste estudo. Sexo desprotegido foi à causa mais frequente para a aquisição do HIV (46,3%), seguido pelo uso de drogas injetáveis ou não injetáveis (14,6%). Relações heterossexuais foram os mais citados (19,5%). Pacientes apresentaram carga viral entre 49 e 750.000 (média de 7.849 ± 124.850) e CD4 variando de 2 a 1.306 (média de 159 ± 250). Em média, as chances de um resultado ser positivo com outras técnicas foram 2,7 vezes maiores do que a chance de um resultado positivo com hematoxilina férrica simplificada. Foram encontradas diferenças significativas entre os métodos (p=0,003). CONCLUSÕES: As outras técnicas são capazes de detectar uma quantidade significativa maior de parasitas em comparação com a hematoxilina férrica simplificada, especialmente em relação à Isospora belli, Cryptosporidium sp., Schistossoma mansoni e Strongyloides stercoralis que não foram encontrados utilizando a hematoxilina e a Endolimax nana e D. fragilis foram mais detectados pela hematoxilina férrica simplificada, principalmente a D. fragilis que não foi detectada pelos outros métodos.

INTRODUCTION: Studies strongly indicate Dientamoeba fragilis as one of the causes of diarrhea in human immunodeficiency virus (HIV) patients. METHODS: The objective of the present study was to evaluate the prevalence of D. fragilis associated with the causes of diarrhea in 82 HIV/ AIDS patients hospitalized at the Instituto de Infectologia Emílio Ribas from September 2006 to November 2008. RESULTS: In total, 105 samples were collected from 82 patients. Unprotected sex was the most frequent cause of HIV infection (46.3%), followed by the use of injectable or non-injectable drugs (14.6%). Patients presented with viral loads of 49-750,000 copies/ mL (average: 73,849 ± 124,850 copies/mL) and CD4 counts ranging of 2-1,306 cells/mm³ (average: 159 ± 250 cells/mm³). On an average, the odds of obtaining a positive result by using the other techniques (Hoffman, Pons and Janer or Lutz; Ritchie) were 2.7 times higher than the chance of obtaining a positive result by using the simplified iron hematoxylin method. Significant differences were found between the methods (p = 0.003). CONCLUSIONS: The other techniques can detect a significantly greater amount of parasites than the simplified iron hematoxylin method, especially with respect to Isospora belli, Cryptosporidium sp., Schistosoma mansoni, and Strongyloides stercoralis, which were not detected using hematoxylin. Endolimax nana and D. fragilis were detected more frequently on using hematoxylin, and the only parasite not found by the other methods was D. fragilis.

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15.

Assessment of antiretroviral response by the less sensitive immunoenzymatic test (detuned Elisa) in HIV-infected/AIDS patients
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CIMERMAN, Sergio

Revista do Instituto de Medicina Tropical de São Paulo

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oct 2002, Volume 44 N. 5 Pages 260 - 260

Abstract: En | Text: En | PDF: En

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