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Press releases Saturday 3 June 2006
Please remember to credit the BMJ
as source when publicising an article and to tell your readers that they can
read its full text on the journal's web site (http://bmj.com).
(1) ARE ANTIBIOTICS
FOR SUSPECTED CHILDHOOD MENINGITIS HARMFUL?
(2) NEW STUDY RE-EVALUATES CARDIOVASCULAR RISKS OF ANTI-INFLAMMATORY DRUGS
(3) CONCERN OVER “AGGRESSIVE” CHOLESTEROL RECOMMENDATIONS
(4) VERY FEW MOTHERS REJECT CHILDHOOD IMMUNISATION
(5) DIETS WITH GROUP SUPPORT MAY HELP KEEP WEIGHT OFF FOR LONGER
(1) ARE ANTIBIOTICS FOR SUSPECTED CHILDHOOD MENINGITIS HARMFUL?
(Parenteral penicillin for
children with meningococcal disease before hospital admission: case-control
study)
http://bmj.com/cgi/content/full/332/7553/1295
(Effectiveness of antibiotics
given before admission in reducing mortality from meningococcal disease:
systematic review)
http://bmj.com/cgi/content/full/332/7553/1299
(Editorial: Parenteral penicillin
before hospitalisation for meningitis)
http://bmj.com/cgi/content/full/332/7553/1283
Should children with suspected meningitis be given antibiotics before transfer to hospital?
Several European countries advise doctors in primary care to do this, but the evidence is conflicting, with some studies suggesting benefit and others suggesting harm. Two papers in this week’s BMJ add to this uncertainty.
One shows that children who are given antibiotics before admission to hospital are more likely to die on reaching hospital. The other – a review of all the current evidence – cannot conclude whether or not pre-hospital antibiotics improve survival.
In the first study, UK researchers analysed 158 children diagnosed with suspected meningococcal disease by a general practitioner before admission to hospital. Two thirds were given parenteral (injected) penicillin, in accordance with national guidelines.
The children who were given penicillin were more likely to die than those who were not given penicillin.
However, the children who received penicillin also had more severe disease on reaching hospital. So, although a harmful effect of penicillin cannot be excluded, a more likely explanation for the higher mortality is that there is a strong bias towards giving penicillin to the most severely ill children, conclude the authors.
In the second paper, an international group of researchers reviewed evidence from 14 studies and found that oral antibiotics given before hospital admission were associated with reduced mortality. Results for parenteral antibiotics were inconsistent, though the data suggest that they might have a beneficial effect when a substantial proportion of patients is treated.
Once again, it is suggested that bias linked to illness severity may explain these results. For example, doctors are likely to prescribe oral antibiotics only in patients with milder disease.
“We cannot conclude from this review whether or not antibiotics given before admission have an effect on case fatality, though the data are consistent with benefit when a substantial proportion of cases are treated,” they write.
So, should doctors change their practice in light of these findings? Probably not, says Duncan Keeley, a general practitioner in an accompanying editorial. But frontline practitioners will be keen to hear a view from the Meningitis Research Foundation once it has considered their implications.
Meanwhile, further analysis of the data is crucial, and we should also remember the contributions general practitioners can make, including educating parents, early diagnosis, and rapid transfer to hospital with optimum supportive care, he writes. These measures may be more important for improving survival than administering parenteral penicillin in the community.
Contacts:
Paper 1: Contact authors via University
of Oxford Press Office, Oxford, UK
Email: press.office@admin.ox.ac.uk
Paper 2: Susan Hahné, Medical
Epidemiologist, National Institute for Public Health and the Environment
(RIVM), Bilthoven, Netherlands
Email: susan.hahne@rivm.nl
(2) NEW STUDY RE-EVALUATES CARDIOVASCULAR RISKS OF ANTI-INFLAMMATORY DRUGS
(Do cyclo-oxygenase-2 inhibitors
and traditional non-steroidal anti-inflammatory drugs increase the risk of
atherothrombosis? Meta-analysis of randomised trials)
http://bmj.com/cgi/content/full/332/7553/1302
(Editorial: Life without
COX-2 inhibitors)
http://bmj.com/cgi/content/full/332/7553/1287
High doses of some traditional non-steroidal anti-inflammatory drugs (NSAIDS) are associated with similar cardiovascular risks as the new generation of anti-inflammatory drugs known as COX 2 inhibitors (like Vioxx ®), finds a study in this week's BMJ.
Researchers from the UK and Italy performed a combined analysis (known as a “meta-analysis”) of all the available randomised trials that compared a COX 2 inhibitor with placebo, or a COX 2 inhibitor with a traditional NSAID, and had recorded serious cardiovascular events. By including data from 138 trials among 140,000 patients, this meta-analysis provides a much more reliable estimate of the cardiovascular risks of these drugs, since individual trials were too small to study this question.
The study showed, as expected, that, COX 2 inhibitors were associated with an increased risk of vascular events, mainly heart attack. Unfortunately, there were insufficient data to reliably assess whether these risks were dose dependent, or whether the risks might differ among aspirin and non-aspirin users.
But the study also showed that high doses of two of the NSAIDs studied, diclofenac and ibuprofen, were associated with a similar increase in the risk of vascular events to COX 2 inhibitors, although the risks of high doses of another NSAID, naproxen, were smaller.
However, the average increased risk of vascular events was modest among the people studied in the trials: For every 1,000 people taking an NSAID or COX 2 inhibitor, around three extra people per year would have a vascular event, most likely a heart attack.
The authors conclude that very large randomised trials are needed to identify which anti-inflammatory drug regimens minimise serious cardiovascular and gastrointestinal problems.
An accompanying editorial discusses other options for treating chronic pain and suggests that doctors work with their patients to choose the best solutions for them.
Contact:
Colin Baigent, Reader in Clinical
Epidemiology, Clinical Trial Service Unit, University of Oxford, UK
Email: colin.baigent@ctsu.ox.ac.uk
(3) CONCERN OVER “AGGRESSIVE” CHOLESTEROL RECOMMENDATIONS
(Should we lower cholesterol
as much as possible?)
http://bmj.com/cgi/content/full/332/7553/1330
New US recommendations for lowering cholesterol levels would increase the risk of harmful side effects with no overall reduction in deaths, warn experts in this week’s BMJ.
The American National Cholesterol Education Program has said that people at high risk of heart disease should be treated more aggressively.
By aggressively, it means that LDL-cholesterol concentrations should be lowered to less than 1.81 millimoles per litre of blood (mmol/l) in high-risk individuals. Current guidelines generally recommend 2.56 mmol/l as a healthy reading.
To achieve this new goal, most of the Western world’s adult population would be on statins, and doses would have to be more than eight times higher than currently used, say the authors. This would increase both the number and seriousness of side effects.
But clinical trials suggest that higher doses of statins do not lower overall mortality and side effects are generally under-reported.
The authors conclude that any reduction in non-fatal events may be outweighed by more numerous and more severe adverse effects.
Contact:
Uffe Ravnskov, Independent Researcher,
Magle Stora Kyrkogata, Lund, Sweden
Email: ravnskov@tele2.se
(4) VERY FEW MOTHERS REJECT CHILDHOOD IMMUNISATION
(Differences in risk factors
for partial and no immunisation in the first year of life: prospective cohort
study)
http://bmj.com/cgi/content/full/332/7553/1312
The mothers of children who are unimmunised differ from those who are partially immunised in a number of ways, finds a study in this week’s BMJ.
This is the first large scale study of its kind in the UK, and suggests that different approaches are needed to maximise uptake of immunisation in these groups.
Researchers from the Institute of Child Health analysed data for 18,488 infants born between September 2000 and January 2002 in the UK. The sample was stratified by UK country and electoral wards to adequately represent infants from ethnic minority groups and disadvantaged backgrounds.
Mothers were interviewed when the infants were about 9 months old. They were shown a card listing the primary vaccines, given at 2, 3, and 4 months of age, and asked if the infants had received three doses of all listed vaccines.
Overall, 3.3% of infants were partially immunised and 1.1% were unimmunised. These rates were highest in England (3.6% and 1.3% respectively).
Partially immunised infants were more likely to come from an ethnic minority group, a disadvantaged background, and a large family. They were also more likely to have a teenaged or lone parent, a mother who smoked during pregnancy, and have been admitted to hospital at least once.
In contrast, unimmunised infants were more likely to have older (40 years or above) and more highly qualified mothers, or mothers of black Caribbean ethnicity.
Mothers cited medical factors relating to their child or family as the predominant reason for partial immunisation. Mothers’ beliefs or attitudes towards immunisation were the main reason cited for no immunisation.
These findings indicate that mothers of unimmunised and partially immunised infants differ in terms of age and education, say the authors. “Our study suggests that different interventions are needed to promote uptake of immunisation among older and more highly qualified mothers who reject primary immunisations,” they conclude.
Contact:
Helen Bedford, Senior Lecturer,
Centre for Paediatric Epidemiology and Biostatistics, Institute of Child
Health, London, UK
Email: h.bedford@ich.ucl.ac.uk
(5) DIETS WITH GROUP SUPPORT MAY HELP KEEP WEIGHT OFF FOR LONGER
(Randomised controlled trial
of four commercial weight loss programmes in the UK: initial findings from
the BBC “diet trials”)
http://bmj.com/cgi/content/full/332/7553/1309
(Editorial:The BBC diet trials)
http://bmj.com/cgi/content/full/332/7553/1284
Commercial diets are a useful way to lose weight. And those based on group support seem to fare better at keeping the weight off in the long term, finds a study in this week’s BMJ.
Please note, this paper was published on bmj.com on 23 May 2006, so is not under embargo.
Researchers compared the effectiveness of four popular commercial weight loss programmes with a control group. The study was sponsored by the BBC as part of its reality TV series, BBC Diet Trials.
The diets were the Slim-Fast Plan (a meal replacement approach), Weight Watchers pure points programme (an energy controlled diet with weekly group meetings), Dr Atkins’ new diet revolution (a self-monitored low carbohydrate eating plan), and Rosemary Conley’s eat yourself slim diet and fitness plan (a low fat diet and weekly exercise class). The control group was asked to maintain their current diet and exercise pattern.
Weight and body fat changes were monitored over six months and dieting behaviour was checked again at 12 months.
After six months, all diets resulted in significant loss of body fat and weight compared to the control group. Average weight loss was 5.9 kg and average fat loss was 4.4. kg (5-10% of body weight). The Atkins diet resulted in significantly higher weight loss during the first four weeks, but by the end, was no more or less effective than the other diets.
There were no significant differences in cardiac risk factors between the diet groups and the control group. The Atkins diet did not lead to substantial increases in cholesterol levels.
At 12 months, 158 participants (54% of the original sample) returned data. Only 58 (45%) were still keeping to their allocated diets (nine to Atkins, 20 to Weight Watchers, nine to Slim-Fast, 20 to Rosemary Conley). More participants in the unsupported programmes (Atkins diet and Slim-Fast) withdrew from the study than in the supported group based programmes, and weight rebound after the initial six months was higher in the unsupported programmes.
The authors conclude that clinically useful weight loss and fat loss can be achieved in adults who are motivated to follow commercial diets for a substantial period. People need to find a diet that best suits them.
“Our study provides data on how much weight patients can expect to lose by dieting,” they write. “These data could help practitioners in managing patients’ expectations of weight loss targets.”
An accompanying editorial suggests that the challenge to researchers is to take weight loss studies to the next level by evaluating long term health outcomes, cost effectiveness, and novel strategies of improving adherence and weight maintenance.
Contact:
Contact author via Peter La, University
of Surrey Press Office, Guildford, UK
Email: p.la@surrey.ac.uk
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SquareLondon WC1H 9JR
(contact: pressoffice@bma.org.uk)
and from:
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