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Manzanares B, González R, Serrano P, Navas A, Alonso C, Fernandez L, Jurado A, Moreno-Aguilar C. Back to basics: likelihood ratios for olive and grass pollen specific IgE in seasonal allergic rhinitis. FRONTIERS IN ALLERGY 2023; 4:1241650. [PMID: 37859976 PMCID: PMC10582635 DOI: 10.3389/falgy.2023.1241650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Specific IgE (sIgE) is merely a sensitization marker that cannot be used for allergy diagnosis if there are no associated clinical symptoms. As of 2023, there is still no evidence regarding the quantity of sIgE necessary to confirm or exclude clinical disease. Therefore, this study aimed to calculate cut-offs for sIgE, allowing us to effectively diagnose olive or grass pollen allergy and select allergenic immunotherapy (AIT) candidate patients in a region under high olive and grass allergenic pressure. Methods An observational retrospective study consisting of the review of electronic medical records from 1,172 patients diagnosed with seasonal rhino-conjunctivitis and suspected allergy to olive or grass pollen. Symptoms correlated with sIgE to Poaceae and Oleaceae whole extracts and sIgE to genuine allergenic components were evaluated. Optimal cut-off values were calculated using receiver operating characteristic curves. Relevant clinical symptoms and AIT indications were taken into consideration when determining the clinical allergy diagnosis. Results sIgE to Lolium showed the best area under the curve (AUC) for both diagnosis (0.957) and an indication of AIT (0.872). The optimal cut-off values for grass diagnosis and AIT indication were 1.79 kUA/L and 8.83 kUA/L, respectively. A value of 5.62 kUA/L was associated with a positive likelihood ratio (LR) of 10.08 set for grass allergy. Olea sIgE showed the best AUC for the diagnosis (0.950). The optimal cut-off for diagnosis was 2.41 kUA/L. A value of 6.49 kUA/L was associated with a positive LR of 9.98 to confirm olive pollen allergy. In regard to immunotherapy, Ole e 1 sIgE showed the best AUC (0.860). The optimal cut-off was 14.05 kUA/L. Ole e 1 sIgE value of 4.8 kUA/L was associated with a 0.09 negative LR to exclude olive AIT indication. Conclusions The sIgE cut-offs found in this population under high olive and grass allergenic pressure reduce the gap between sensitization and clinical allergy, providing a new tool for the diagnosis of seasonal allergic rhinitis/asthma and helping to discriminate patients who will benefit from AIT.
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Affiliation(s)
- Bárbara Manzanares
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofia University Hospital/ University of Córdoba, Córdoba, Spain
- Department of Immunology and Allergy, Reina Sofia University Hospital, Córdoba, Spain
- Postdocs CSYF, Code RH-0060-2020, European Social Fund, Sevilla, Spain
| | - Rafael González
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofia University Hospital/ University of Córdoba, Córdoba, Spain
- Department of Immunology and Allergy, Reina Sofia University Hospital, Córdoba, Spain
- National Network ARADyAL, Health Institute Carlos III, Madrid, Spain
| | - Pilar Serrano
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofia University Hospital/ University of Córdoba, Córdoba, Spain
- Department of Immunology and Allergy, Reina Sofia University Hospital, Córdoba, Spain
- National Network ARADyAL, Health Institute Carlos III, Madrid, Spain
| | - Ana Navas
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofia University Hospital/ University of Córdoba, Córdoba, Spain
- Department of Immunology and Allergy, Reina Sofia University Hospital, Córdoba, Spain
| | - Corona Alonso
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofia University Hospital/ University of Córdoba, Córdoba, Spain
- Department of Immunology and Allergy, Reina Sofia University Hospital, Córdoba, Spain
| | - Lourdes Fernandez
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofia University Hospital/ University of Córdoba, Córdoba, Spain
- Department of Immunology and Allergy, Reina Sofia University Hospital, Córdoba, Spain
| | - Aurora Jurado
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofia University Hospital/ University of Córdoba, Córdoba, Spain
- Department of Immunology and Allergy, Reina Sofia University Hospital, Córdoba, Spain
- National Network ARADyAL, Health Institute Carlos III, Madrid, Spain
| | - Carmen Moreno-Aguilar
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofia University Hospital/ University of Córdoba, Córdoba, Spain
- Department of Immunology and Allergy, Reina Sofia University Hospital, Córdoba, Spain
- National Network ARADyAL, Health Institute Carlos III, Madrid, Spain
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Lee JH, Park CS, Pyo MJ, Ryang Lee A, Shin E, Yoo YS, Song WJ, Kim TB, Cho YS, Kwon HS. Intradermal testing increases the accuracy of an immediate-type cefaclor hypersensitivity diagnosis. World Allergy Organ J 2022; 15:100643. [PMID: 35432713 PMCID: PMC8983408 DOI: 10.1016/j.waojou.2022.100643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/18/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Hypersensitivity reactions to cefaclor have increased in accordance with its frequent use. However, only limited data are available on the diagnostic value of skin tests for these conditions, particularly intradermal tests (IDTs). Objective To evaluate the clinical usefulness of IDT compared to the ImmunoCAP test in patients with cefaclor-induced immediate-type hypersensitivity. Methods We conducted a retrospective chart review from January 2010 to June 2020 of adult subjects from 2 tertiary hospitals in Korea with a history of suspected immediate-type hypersensitivity to cefaclor, and who had undergone ImmunoCAP and IDT. Results Overall, 131 subjects diagnosed with cefaclor hypersensitivity were included in the analysis. Fifty-nine patients (59/131, 45.04%) were positive in both IDT and ImmunoCAP. Fifty-four (54/131, 41.22%) and 6 (6/131, 4.58%) subjects showed positive results only with IDT or the ImmunoCAP test, respectively. Twelve subjects (12/131, 9.16%) were negative by both tests but reacted positively in a drug provocation test. The frequency of IDT positivity was similar regardless of the severity of reactions. However, positivity of ImmunoCAP was lower in subjects with mild reactions compared to those with anaphylaxis. Regarding the diagnosis of cefaclor hypersensitivity, the overall sensitivity of IDT and ImmunoCAP was 0.863 and 0.496, respectively while the specificity was 1. The combination of IDT and ImmunoCAP further increased this sensitivity to 0.908. Conclusion IDT was more sensitive than ImmunoCAP for the diagnosis of cefaclor allergy, regardless of the severity of the hypersensitivity reaction. Therefore, we recommend a combination of IDT and ImmunoCAP for the diagnosis of cefaclor hypersensitivity.
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Affiliation(s)
- Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chan Sun Park
- Department of Allergy and Clinical Immunology, Inje University of College of Medicine, Haeundae Paik Hospital, Busan, South Korea
| | - Min Ju Pyo
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - A. Ryang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eunyong Shin
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Sang Yoo
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - You-Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Corresponding author. Hyouk-Soo Kwon, M.D., Ph.D.; Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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Rhyou HI, Nam YH, Kim SC, Doo GE, Ha CY, Nam HJ, Woo SD, Lee Y, Jang JH, Lee HY, Ye YM. Cefaclor-induced hypersensitivity: Differences in the incidence of anaphylaxis relative to other 2nd and 3rd generation cephalosporins. PLoS One 2021; 16:e0254898. [PMID: 34293048 PMCID: PMC8297852 DOI: 10.1371/journal.pone.0254898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/06/2021] [Indexed: 12/05/2022] Open
Abstract
Cefaclor, a second-generation oral cephalosporin, is the most frequently prescribed cephalosporin in Korea. Studies, however, have yet to analyze the incidence of cefaclor-associated adverse drug reactions (ADRs), including hypersensitivity (HS), according to total national usage rates. This study aimed to investigate the incidence rates and clinical features of cefaclor ADRs reported to the Korean Adverse Event Reporting System (KAERS) and Health Insurance Review and Assessment Service (HIRA) database for the most recent 5 years. Reviewing the HIRA database, which contains information on all insurance claims, including prescribed medications and patient demographics, we identified the total number of individuals who had been prescribed cefaclor and other cephalosporins including 2nd generation without cefaclor and 3rd generation antibiotics from January 2014 to December 2018. Additionally, we retrospectively analyzed all ADRs reported to the KAERS for these drugs over the same study period. Incidence rates for ADRs, HS, and anaphylaxis to cefaclor were 1.92/10,000 persons, 1.17/10,000 persons, and 0.38/10,000 persons, respectively, lower than those to other 2nd and 3rd cephalosporins. Among all ADRs, HS (60.9% vs. 43.6% vs. 44.8%, P <0.001) and anaphylaxis (19.8% vs. 4.6% vs. 4.7%, P <0.001) were more common for cefaclor than for other 2nd and 3rd cephalosporins. Females, individuals under 65 years of age, concomitant use of drugs, and serious ADRs were more strongly associated with HS to cefaclor than with HS to other 2nd and 3rd cephalosporins. In a nationwide database for the Korean population, the incidence of cefaclor-induced ADRs, particularly HS and anaphylaxis, was high. Female sex, age younger than 65 years, and concomitant use of drugs may be associated with HS to cefaclor.
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Affiliation(s)
- Hyo-In Rhyou
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
- Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, Busan, Korea
| | - Young-Hee Nam
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
- Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, Busan, Korea
| | - Su-Chin Kim
- Clinical Trial Center, Ajou University Hospital, Suwon, Korea
| | - Go-Eun Doo
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
| | - Chae-Yeon Ha
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
| | - Hee-Joo Nam
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
- Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, Busan, Korea
| | - Sung-Dae Woo
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Youngsoo Lee
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Hyuk Jang
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hyun-Young Lee
- Clinical Trial Center, Ajou University Hospital, Suwon, Korea
| | - Young-Min Ye
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, Suwon, Korea
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
- * E-mail:
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Rhyou HI, Doo GE, Yoon J, Ha CY, Nam HJ, Woo SD, Lee Y, Nam YH, Ye YM. Clinical characteristics and risk factors for cefaclor-induced immediate hypersensitivity: a retrospective observation at two university hospitals in Korea. Allergy Asthma Clin Immunol 2021; 17:20. [PMID: 33588929 PMCID: PMC7885353 DOI: 10.1186/s13223-021-00523-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/01/2021] [Indexed: 12/11/2022] Open
Abstract
Background Cefaclor, a second-generation oral cephalosporin, is widely prescribed to treat infectious diseases. Immediate hypersensitivity (HS) reactions to cefaclor have continuously been reported and are expected to increase with its greater use. This study aimed to investigate the clinical characteristics and risk factors of immediate HS to cefaclor over the most recent 5 years. Methods This retrospective study investigated 521 adverse drug reactions (ADRs) to cefaclor at pharmacovigilance centers at two tertiary hospitals from January 2014 to December 2018. In total, 459 patients with immediate HS to cefaclor were reviewed. Results A total of 459 cases of cefaclor immediate HS were included among 521 cefaclor ADRs, and anaphylaxis was recorded in 61.2%. Female sex (odds ratio 2.917, 95% confidence interval 2.397–3.550, P < 0.001), age under 65 years (4.225, 3.017–5.916, P < 0.001), hypertension (2.520, 1.875–3.388, P < 0.001), liver diseases (2.189, 1.208–3.967, P = 0.010), asthma (8.075, 5.301–12.302, P < 0.001), and concomitant use of nonsteroidal anti-inflammatory drugs (1.888, 1.554–2.294, P < 0.001) were significantly associated with cefaclor immediate HS. Conclusions Cefaclor was found to elicit high proportions of immediate HS and anaphylaxis. Physicians ought to be cautious with prescribing cefaclor to females, individuals with hypertension, liver diseases, or asthma, and patients taking nonsteroidal anti-inflammatory drugs. Trial registration This study was retrospectively registered.
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Affiliation(s)
- Hyo-In Rhyou
- Department of Internal Medicine, College of Medicine, Dong-A University, 26 Daesingongwon-ro, Seo-Gu, Busan, Korea.,Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-Gu, Busan, Korea
| | - Go-Eun Doo
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea
| | - Jiwon Yoon
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea
| | - Chae-Yeon Ha
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea
| | - Hee-Joo Nam
- Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-Gu, Busan, Korea.,Department of Pharmacy, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-Gu, Busan, Korea
| | - Sung-Dae Woo
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea.,Department of Allergy and Clinical Immunology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea
| | - Youngsoo Lee
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea.,Department of Allergy and Clinical Immunology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea
| | - Young-Hee Nam
- Department of Internal Medicine, College of Medicine, Dong-A University, 26 Daesingongwon-ro, Seo-Gu, Busan, Korea. .,Dong-A Regional Pharmacovigilance Center, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-Gu, Busan, Korea.
| | - Young-Min Ye
- Ajou Regional Pharmacovigilance Center, Ajou University Hospital, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea. .,Department of Allergy and Clinical Immunology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 443-721, Korea.
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Yuson C, Kumar K, Le A, Ahmadie A, Banovic T, Heddle R, Kette F, Smith W, Hissaria P. Immediate cephalosporin allergy. Intern Med J 2020; 49:985-993. [PMID: 30667130 DOI: 10.1111/imj.14229] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/18/2018] [Accepted: 01/09/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients who suffer from acute IgE-mediated allergy to a cephalosporin antibiotic are frequently assumed to be at high risk of allergy to other cephalosporins and penicillins. AIM To define cross-reactivity patterns in patients with confirmed allergy to a cephalosporin. METHODS Subjects presenting with a history of immediate allergy to a cephalosporin-family antibiotic between March 2009 and July 2017 were investigated with specific IgE testing to penicillin, amoxycillin and cefaclor, followed by skin prick testing, intradermal testing and drug provocation testing with a panel of penicillins and cephalosporins. RESULTS Out of 564 subjects with a reported beta-lactam allergy, 90 identified a cephalosporin as their index drug. Fifty-five (61.1%) of the 90 subjects tested had a history consistent with an IgE-mediated reaction, of whom 24 (43.6%) were proven to be allergic to their index cephalosporin. Twenty (83.3%) of the 24 were allergic only to their index cephalosporin. Of the four remaining subjects, two were co-sensitised to another beta-lactam with a similar side chain, while the other two had no specific cross-reactivity pattern. Major and minor penicillin determinants were negative for all cephalosporin-allergic individuals. CONCLUSION In our cohort, cephalosporin allergy does not appear to be a class effect, with most cases found allergic only to their index cephalosporin. Co-sensitisation to other cephalosporins or penicillins was uncommon, and when it occurred, was usually consistent with side chain cross-reactivity.
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Affiliation(s)
- Carlo Yuson
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kimti Kumar
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Adriana Le
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Aida Ahmadie
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tatjana Banovic
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert Heddle
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Frank Kette
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - William Smith
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Pravin Hissaria
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Li P, Jiang G, Shen X. Evaluation of 3-day azithromycin or 5-day cefaclor in comparison with 10-day amoxicillin for treatment of tonsillitis in children. Can J Physiol Pharmacol 2019; 97:939-944. [PMID: 31365280 DOI: 10.1139/cjpp-2019-0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
To evaluate the clinical efficacy of azithromycin, cefaclor, and amoxicillin in treatment of pediatric tonsillitis, a total of 256 children with Group A β-hemolytic streptococcus (GAS) tonsillitis were randomly divided into 3 groups. Only patients assessed with streptococcus-positive tonsillitis, considered to be compliant with treatment and complete clinical and microbiological evaluations at the end of therapy (day 14) and follow-up (day 30) were included in the efficacy analysis. Our study demonstrated that 96.4% of patients in the azithromycin group, 92.4% of patients in the cefaclor group, and 91.0% of patients in the amoxicillin group were recorded as clinical success at the end of therapy. Bacteriological eradication rates of the 3 groups at the end of therapy were 94.0%, 89.9%, and 88.5%, respectively. A pathogen recurrence rate was evaluated as 2.6%, 7.0%, and 5.9% at the follow-up. Treatment-stimulated adverse events occurred in 2.4% of patients in the azithromycin group, 11.3% in the cefaclor group, and 11.4% in the amoxicillin group. In summary, azithromycin showed an effective tendency for the treatment of pediatric tonsillitis with lower occurrence rate of adverse reactions, although there is no statistical significance for the clinical and bacteriological eradication efficacy between these 3 groups.
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Affiliation(s)
- Peng Li
- Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing 210008, Jiangsu, China
| | - Genqin Jiang
- Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing 210008, Jiangsu, China
| | - Xiaofei Shen
- Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing 210008, Jiangsu, China.,Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing 210008, Jiangsu, China
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