Diagnóstico y tratamiento de la infección por Bordetella pertussis. Guía de Práctica Clínica
DOI:
https://doi.org/10.47464/MetroCiencia/vol33/2/2025/52-65Palabras clave:
Tos ferina, Bordetella pertussis, pediatría, diagnóstico molecular, azitromicina, profilaxis posexposición, exanguinotransfusión, inmunización, guía de práctica clínica, enfermedades prevenibles por vacunaciónResumen
Introducción: La tos ferina continúa siendo una enfermedad respiratoria altamente contagiosa y letal en lactantes, a pesar de la vacunación. En Ecuador y otros países, el resurgimiento de Bordetella pertussis se asocia a fallas vacunal, menor duración de inmunidad inducida por vacunas acelulares y circulación de cepas deficientes en pertactina. Esta guía pretende estandarizar el diagnóstico y tratamiento en pediatría, especialmente en contextos de limitados recursos diagnósticos. Metodología: Se empleó una revisión rápida según directrices internacionales y el enfoque GRADE. Las preguntas clínicas se formularon bajo el esquema PICO. Se seleccionaron estudios de calidad (ensayos clínicos, estudios observacionales analíticos, revisiones sistemáticas) usando herramientas asistidas por inteligencia artificial. La evidencia fue sintetizada y evaluada según su calidad y aplicabilidad clínica. Resultados: Se analizaron 38 estudios relevantes. Se confirmó que la PCR es superior al cultivo en sensibilidad diagnóstica. El tratamiento con azitromicina (3–5 días) mostró similar eficacia a eritromicina pero con mejor adherencia y menos efectos adversos. La profilaxis posexposición temprana con macrólidos reduce la transmisión secundaria. La exanguinotransfusión podría ser útil en lactantes con leucocitosis severa, aunque su evidencia aún es limitada. Se desaconseja el uso rutinario de esteroides, óxido nítrico y ECMO por asociarse a mayor mortalidad. Conclusiones: Esta guía proporciona recomendaciones sólidas para mejorar el diagnóstico oportuno, tratamiento y prevención de la tos ferina pediátrica, con énfasis en la aplicabilidad en sistemas de salud con recursos limitados y en la protección de grupos vulnerables como los lactantes.
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Derechos de autor 2025 María de los Ángeles Costta Michuy, Maria Nathaly Velastegui Peralta, Rina Johanna Silva Galarza, Adriana Verónica Arnao Noboa, Dolores Elaine Freire Jijón, Judith Rosabel Soffe Pazmiño, Christian Javier Campoverde Espinoza, Maria Vanessa Martínez Astudillo, Carola Katherine Cedillo Villamagua, Franklin André Espinosa Méndez, Flor Narciza Chamba Quezada, Ana Cristina Medranda Alcívar, Jaime David Acosta España
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