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Press releases Saturday 10 June 2006
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(1) ARE ANTIBIOTICS
BEING USED FOR TOO LONG?
(2) NHS COULD SAVE £2BN BY USING GENERIC CHOLESTEROL DRUGS
(3) HEALTH PROFESSIONALS MUST HELP TACKLE CLIMATE CHANGE
(4) WARNING FOR BUDDING YOUNG FOOTBALLERS PLAYING IN NEW BOOTS
(1) ARE ANTIBIOTICS BEING USED FOR TOO LONG?
(Effectiveness of discontinuing
antibiotic treatment after three days versus eight days in mild to moderate-severe
community acquired pneumonia: randomised double blind study)
http://bmj.com/cgi/content/full/332/7554/1355
(Commentary: What is the optimal
duration of antibiotic therapy?)
http://bmj.com/cgi/content/full/332/7554/1358
Taking antibiotics for three days is just as effective for community acquired pneumonia as continuing treatment for the recommended 7-10 days, finds a study in this week’s BMJ. Shorter treatment can also help contain growing resistance rates.
The study raises questions about the optimal duration of antibiotic therapy for common infections.
Community acquired pneumonia is one of the most important indications for antibiotic prescriptions in hospitals. But a lack of evidence to support short course therapy means it has become accepted practice to continue treatment for days after symptoms have improved.
Researchers in the Netherlands compared the effectiveness of discontinuing treatment with amoxicillin after three days or eight days in adults admitted to hospital with mild to moderate-severe community acquired pneumonia.
119 patients who substantially improved after the conventional three days’ treatment with intravenous amoxicillin were randomly assigned to oral amoxicillin (63 patients) or placebo (56 patients) three times daily for five days. Patients were assessed at days 7, 10 (two days after treatment ended), 14, and 28.
In the three day and eight day treatment groups, the clinical success rate at day 10 was 93% for both, and at day 28 was 90% compared with 88%. Both groups had similar resolution of symptoms, x-ray results, and length of hospital stay.
These findings show that discontinuing amoxicillin treatment after three days is not inferior to discontinuing it after eight days in adults with mild to moderate-severe community acquired pneumonia who have substantially improved after an initial three days’ treatment, say the authors.
A shorter duration of treatment can also help to reduce overall antibiotic consumption and resistance rates for respiratory infections, they conclude.
This study suggests that current guidelines recommending 7-10 days should be revised, says Dr John Paul from the Royal Sussex County Hospital, in an accompanying commentary.
Not only does the study yield strong evidence in favour of short course therapy for a subset of patients with community acquired pneumonia, but also shows how centres can cooperate to tackle longstanding areas of uncertainty in clinical microbiology and infectious diseases, he writes. Many other common clinical situations would repay the efforts of comparable approaches.
Contact:
Jan M Prins, Internist in Infectious
Diseases, Department of Internal Medicine, Division of Infectious Diseases,
Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, Netherlands
Email: j.m.prins@amc.uva.nl
(2) NHS COULD SAVE £2BN BY USING GENERIC CHOLESTEROL DRUGS
(Editorial: Switching statins)
http://bmj.com/cgi/content/full/332/7554/1344
The NHS in England could save over £2bn in the next five years if doctors simply switched patients to cheaper generic cholesterol lowering drugs (statins), say two senior doctors in this week’s BMJ.
Statins are one of the great success stories of preventive medicine, write James Moon and Richard Bogle. Prescriptions have increased by 30% every year in England and statins represent the largest part of the NHS drug bill (£738 million in 2004).
Statin prescribing is dominated by atorvastatin and simvastatin and over 40% of all prescribing is for atorvastatin. The majority (85%) of these prescriptions are for the lower doses of atorvastatin (10 and 20 mg). In May 2003 the UK simvastatin patent expired and in 2006 simvastatin costs six times less than atorvastatin.
This fall in price will save the NHS about £1bn in the next five years, say the authors. However, atorvastatin will remain on patent until 2011 and by simply switching from the expensive lower doses of atorvastatin to cheaper simvastatin, doctors could save a further £1 billion.
The number of statin prescriptions is set to rise sharply following the publication of new guidelines from the National Institute for Health and Clinical Excellence (NICE). These guidelines recommend that 5.2 million (14% of the adult population) should be taking statins and this will cost an extra £250m per year. If generic simvastatin was universally prescribed for these people, the costs would actually fall by £185m a year.
Several large independent studies have proven that both statins are equally safe and effective. The only important difference is cost. So, is there any justification to continue to prescribe lower doses of atorvastatin when simvastatin 40mg is so much cheaper, ask the authors?
At University College London Hospitals NHS Foundation Trust simvastatin is now the first line statin. This simple change will save the trust £80,000 a year. Switching programmes to replace lower dose atorvastatin with simvastatin are also in place in at least three London primary care trusts. These local initiatives need to be replicated nationally to realise the full economic benefits of generic simvastatin, as has happened in other European countries, say the authors.
“It is time for the United Kingdom to implement therapeutic substitution of simvastatin nationally by switching patients currently taking lower doses of atorvastatin, and prescribing generic simvastatin 40mg for new patients needing primary prevention of coronary heart disease,” they write. “This policy would save £2bn, increase value for money, and release much needed resources to other areas of the NHS.”
Contact:
James Moon, Specialist Registrar,
Department of Cardiology, Heart Hospital, UCL Hospitals NHS Foundation Trust,
London, UK
(3) HEALTH PROFESSIONALS MUST HELP TACKLE CLIMATE CHANGE
(Healthy response to climate
change)
http://bmj.com/cgi/content/full/332/7554/1385
(Commentary: Personal carbon
allowances)
http://bmj.com/cgi/content/full/332/7554/1387
(Editorial: What health services
could do about climate change)
http://bmj.com/cgi/content/full/332/7554/1343
Climate change is a major public health threat which health professionals must help to tackle, argues an expert in this week’s BMJ.
The most feasible policy for tackling global warming is contraction and convergence – a carbon cap and trade policy designed to stabilise and then reduce global carbon dioxide emissions, writes Dr Robin Stott.
The first step in implementing this policy is to set a global carbon budget. This initial budget is then reduced (contracted) at an agreed pace and time until the amount of allocated carbon equals the globe’s carrying capacity. Convergence is the move towards an equal carbon allowance for every person. People with low energy use can then trade their surplus to those with high energy use.
This policy offers a way forward which is globally just and produces many health benefits, such as encouraging more physical activity among people in industrialised societies. Trading in carbon will also transfer money from rich to poor countries, and help deliver the millennium health goals.
“The financial implications of trading in carbon entitlements mean it will be in everyone’s interest to minimise the amount of carbon we emit,” writes the author. But can this policy be made to work?
The political courage and will to implement contraction and convergence is gaining ground, he says. This high level support must now be deepened and formalised so that politicians worldwide commit themselves to the policy.
Health professionals must also set an example and advocate for contraction and convergence both locally and nationally, he concludes.
This process will be a far more effective driver towards minimising the impact of climate change than attempting to encourage individuals to adopt green practices, adds Dr Mayer Hillman in an accompanying commentary. Carbon allowances will act as a parallel currency to real money as well as creating an ecologically virtuous circle.
Finally, an editorial suggests that, if medicine is about saving lives, then working to alter patterns of behaviour that contribute to climate change could arguably become a priority for clinicians - as an urgent preventative measure. Likewise, institutions of health care – in particular the NHS – have enormous power to do good or harm to the natural environment and to increase or diminish carbon emissions.
The author, Anna Coote, describes some examples of good practice, but points out that these depend on highly committed individuals innovating against the odds. Incentives in the NHS run in the opposite direction and no-one gets fired for failing to reduce the carbon footprint of a hospital or clinic.
By 2010, £11 billion will be spent on new hospitals that are largely unsustainable. And so, in the name of ‘healthcare,’ gargantuan sums of public money continue to be spent in ways that are careless of the physical and mental wellbeing of future generations, she writes.
However, without action, “we will be knowingly handing over a dying planet to the next generation,” concludes Dr Hillman.
Contacts:
Paper: Robin Stott, Vice Chair, Medact,
London, UK
Email: stott@dircon.co.uk
Commentary: Mayer Hillman, Senior
Fellow Emeritus, Policy Studies Institute, London, UK
Email: mayer.hillman@blueyonder.co.uk
Editorial: Anna Coote, Lead Commissioner
for Health, Sustainable Development Commission, London, UK
Email: anna.coote@healthcarecommission.org.uk
(4) WARNING FOR BUDDING YOUNG FOOTBALLERS PLAYING IN NEW BOOTS
(Lesson of the week: New football
boots and toxic shock syndrome)
http://bmj.com/cgi/content/full/332/7554/1376
As the World Cup kicks off, doctors in this week’s BMJ report an unusual condition that can develop in budding young footballers.
They describe two cases of toxic shock syndrome (TSS) in children after playing football in new boots. Both developed friction blisters over their Achilles tendons. The blisters contained Staphylococcus aureus, which in one case was found to express the toxic shock syndrome gene (TSS1).
In the first case, a 13-year-old girl developed friction blisters over both heels after playing a competitive game of football in new boots. She was admitted to her local hospital after developing a range of symptoms including fever, rash, abnormally low blood pressure (hypotension), vomiting and diarrhoea.
Further examination revealed a blister, 2cm in diameter, over each of her Achilles tendons containing the bacterium Staphylococcus aureus with the toxic shock syndrome gene (TSS1). A diagnosis of toxic shock syndrome was made and she was treated with antibiotics.
In the second case, a healthy 11-year-old boy played football in a new pair of boots, causing a blister on his right heel. Over the next two days he developed fever, vomiting and diarrhoea, and a rash.
Within hours of admission to hospital, his condition deteriorated and his blood pressure fell. Again, pus from the blister on his heel contained Staphylococcus aureus. He also developed a secondary rash during convalescence.
Toxic shock syndrome has become less common since the link with tampon use was recognised in the 1980s, write the authors. And in children, for whom this association does not apply, the syndrome is rare. But these cases show that the syndrome may follow relatively trivial skin trauma.
They suggest that doctors consider toxic shock syndrome in a child with rash, fever and hypotension. They also stress the need to search carefully for the primary infection, as it may not be immediately obvious, and to be aware that secondary rashes occur.
Contact:
Mark Taylor, Consultant Paediatric
Nephrologist, Department of Nephrology, Birmingham Children’s Hospital, Birmingham,
UK
Email: cm.taylor@bch.nhs.uk
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