This week in the BMJ
Volume 332, Number 7553, Issue of 3 Jun 2006Prehospital penicillin for meningococcal disease might be harmful...
Prehospital penicillin for meningococcal disease might be harmful...
In a case-control study Harnden and colleagues (p 1295) found that administration of parenteral penicillin in primary care to children suspected of having meningococcal disease was associated with a sevenfold increase in mortality. The study included 158 children treated for meningococcal disease in England, Wales, and Northern Ireland between 1997 and 1999 who were diagnosed by a general practitioner before referral to a hospital. In an accompanying commentary, Perera (p 1297) warns how a simple choice in the analysis can change the results from modestly beneficial to substantially harmful. He also questions whether the variables used in the study sufficiently adjusted for severity of the disease.
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...but such findings are likely to be confounded by disease severity
The effects of giving antibiotics before hospital admission to children with meningococcal disease are unclear, and observational studies are unlikely to provide conclusive evidence. A systematic review by Hahné and colleagues (p 1299) found 14 cohort studies of prehospital treatment. It seems that oral antibiotics were beneficial and some studies found that parenteral antibiotics were harmful, but the authors argue that these results are confounded by severity of the disease, which cannot be fully adjusted for. Only a randomised controlled trial could answer the research question.
COX 2 inhibitors and some NSAIDs increase the risk of vascular events
Use of selective COX 2 inhibitors is associated with a 1.4-fold increase in the risk of myocardial infarction, stroke, or vascular death compared with placebo; large doses of diclofenac and ibuprofen are also associated with an increased risk, whereas large doses of naproxen are not. In a meta-analysis of 138 randomised trials and almost 150 000 participants, Kearney and colleagues (p 1302) didn't have enough data to adequately assess whether the excess risk was dose dependent, but the hazard was not confined to long term use only.
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Cardiologists provide best care for patients with MI
Patients with myocardial infarction who are admitted to a hospital under the care of cardiologists get more appropriate treatment and have a significantly lower 90 day mortality than patients admitted under the care of non-cardiologists; they are also younger and have less comorbidity. Birkhead and colleagues (p 1306) used the national audit of myocardial infarction to examine treatment and outcomes for nearly 90 000 patients hospitalised in England and Wales in 2004 and 2005. Just over a third of patients were admitted by cardiologists, and one in five patients were admitted to a hospital with coronary interventional facilities.
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Dieting for six months pays off irrespective of the regimen
Following any one of four commercial dieting regimens (Atkins', Weight Watchers, Slim-Fast, and Rosemary Conley's) significantly reduces weight and body fat over six months compared with no dieting. Truby and colleagues (p 1309) randomised 300 otherwise healthy overweight or obese adults to one of the diets or a delayed treatment control group. The average weight loss in the intervention groups was 5.9 kg, and fat loss was 4.4 kg. Atkins' was the most successful diet during the first four weeks, but, overall, slimming did not depend on the regimen followed.
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