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NEWS - Pharmacists / Pharmacology

Extended antibiotic infusions could save lives: Here’s how to do it – PulmCCM (free)

Related Research: Mortality lower with prolonged vs. short-term IV infusion of antipseudomonal beta-lactams (free)

“The simplest (and cheapest) technique is simply to reduce the time between doses.”

 


Seven days of antibiotics were as good as 14 for gram-negative bacteremia – PulmCCM (free)

Related Commentary: Seven-day antibiotic course delivers similar outcomes to 14-days for Gram-negative bacteraemia – European Society of Clinical Microbiology and Infectious Diseases, via EurekAlert (free)

“It’s important to note that source control was believed to be achieved in all enrolled patients. If source control cannot be achieved (e.g., an abscess, or an infected heart valve or indwelling catheter that cannot safely be removed), prolonged antibiotic courses are often advisable.”

 


Aspirin Plus Clopidogrel vs Aspirin Alone for Preventing Cardiovascular Events Among Patients at High Risk for Cardiovascular Events – JAMA (free for a limited period)

“Clopidogrel+ASA: Reduced risk for MI and ischemic stroke – Increased risk for major bleeding compared with aspirin alone. Combined therapy is NOT associated with lower mortality.” (via @ehlJAMA see Tweet)

 


Antidepressant Withdrawal Syndrome – Therapeutics Initiative (free)

Related Perspective: Many People Taking Antidepressants Discover They Cannot Quit – The New York Times (10 articles per month are free)

“Antidepressants should be added to the list of drugs associated with tolerance, dependence and a withdrawal syndrome.”

“Withdrawal symptoms occur in at least one-third of patients who stop.”

 


Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose: analysis of individual patient data from randomised trials – The Lancet (free)

Commentaries: Weight-adjusted aspirin for cardiovascular prevention – The Lancet (free) AND One dose of aspirin doesn’t fit all – University of Oxford (free)

Practice Changing Article. “Low doses of aspirin (75–100 mg) were only effective in preventing vascular events in patients weighing less than 70 kg, and had no benefit in the 80% of men and nearly 50% of all women weighing 70 kg or more. By contrast, higher doses of aspirin were only effective in patients weighing 70 kg or more.”

 


The right diet can boost potency of cancer drugs – Nature News (free)

Original article: Suppression of insulin feedback enhances the efficacy of PI3K inhibitors – Nature (link to abstract – $ for full-text)

Related: Top oncologist to study effect of diet on cancer drugs – The Guardian (free)

“Diets appear to matter in mouse cancer Rx – can these preclinical findings be translated to humans?” (via @Aiims1742 see Tweet)

 


Antibiotics should be restricted for COPD – National Institute for Health and Care Excellence (free)

Commentaries: Antibiotics should be restricted for COPD, says NICE – OnMedica (free) AND UK officials recommend limits on antibiotics for COPD – CIDRAP (free)

“The draft antimicrobial guidance recommends that antibiotics should be offered to people who have a severe flare up of symptoms, also known as a severe acute exacerbation”

 


Long-acting Reversible Contraception—Highly Efficacious, Safe, and Underutilized – JAMA (free for a limited period)

Clinical Review Audio: Return of the IUD: Long-acting Reversible Contraception Is Safe and Effective (free)

 


Metformin exposure in first trimester of pregnancy and risk of all or specific congenital anomalies: exploratory case-control study – The BMJ (free)

In this large international, population-based database, no evidence was found of an overall increased risk of congenital anomalies after first trimester metformin exposure.

 


Association of Initiation of Basal Insulin Analogs vs Neutral Protamine Hagedorn Insulin With Hypoglycemia-Related Emergency Department Visits or Hospital Admissions and With Glycemic Control in Patients With Type 2 Diabetes – JAMA (free for a limited period)

Editorial: Revisiting NPH Insulin for Type 2 Diabetes: Is a Step Back the Path Forward? (free for a limited period)

Clinical Review Audio: Health Care Spending Gone Wild: Using Expensive Insulin Analogs With Few Clinical Advantages (free)

“Long-acting insulin analogs not associated with reduced hypoglycemia-related ED visits or hospital admissions when compared with NPH insulin, despite costing 5-10x as much” (via @jsross119 see Tweet)

 


Association of Antidepressant Use With Drug-Related Extrapyramidal Symptoms: A Pharmacoepidemiological Study – Journal of Clinical Psychopharmacology (link to abstract – $ for full-text)

Commentaries: Incidence of Extrapyramidal Symptoms Higher With Certain Antidepressants – MPR (free) AND Antidepressants tied to Parkinson’s-like symptoms – Univadis (free registration required)

“Observational study: Incidence of EPSs with antidepressants. RRs: duloxetine, 5.68; mirtazapine, 3.78; citalopram, 3.47; escitalopram, 3.23; paroxetine, 3.07; sertraline, 2.57; venlafaxine, 2.37; bupropion, 2.31; and fluoxetine, 2.03 (all significant)” (via @psychopharmacol see Tweet)

 


Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs – American Academy of Neurology and the American Epilepsy Society

Part I: Treatment of new-onset epilepsy (free PDF)

Part II: Treatment-resistant epilepsy (free PDF)

Commentary: New Epilepsy Guidelines Shed Light on Explosion of New Drugs – MedPage Today (free registration required)

 


A Placebo-Controlled Trial of Bezafibrate in Primary Biliary Cholangitis – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries: A Trial of Bezafibrate in Primary Biliary Cholangitis – NEJM Resident 360 (free) AND Bezafibrate Normalizes Liver Enzymes in PBC – MedPage Today (free registration required)

“In a randomized trial of patients with primary biliary cholangitis, bezafibrate and ursodeoxycholic acid resulted in a higher rate of complete biochemical response than ursodeoxycholic acid alone” (via @NEJM see Tweet with visual abstract)

 


Continuous low-dose antibiotic prophylaxis to prevent urinary tract infection in adults who perform clean intermittent self-catheterisation: the AnTIC RCT – Health Technology Assessment (free)

“The results of this large randomised trial, conducted in accordance with best practice, demonstrate clear benefit for antibiotic prophylaxis in terms of reducing the frequency of UTI for people carrying out CISC”.

 


Stimulants for ADHD in children: Revisited – Therapeutics Initiative (via @AllenFrancesMD)

“There is convincing evidence that a proportion of boys and girls treated with stimulants in BC and around the world are simply the youngest in their class”

 


Effect of Fremanezumab Compared With Placebo for Prevention of Episodic Migraine: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)

Commentary: Fremanezumab effective in preventing episodic migraine – 2 Minute Medicine (free)

“Among patients with episodic migraine in whom multiple medication classes had not previously failed, subcutaneous fremanezumab, compared with placebo, resulted in a statistically significant 1.3- to 1.5-day reduction in the mean number of monthly migraine days over a 12-week period”. (from JAMA)

“The small effect size in terms of reduction in number of days with migraine dampens enthusiasm for this medication, though without head-to-head comparison against other prophylactics, this is hard to assess” (from 2 Minute Medicine)

 


Aldosterone Antagonist Therapy and Mortality in Patients With ST-Segment Elevation Myocardial Infarction Without Heart Failure: A Systematic Review and Meta-analysis – JAMA Internal Medicine (free for a limited period)

Invited Commentary: Mineralocorticoid Receptor Antagonists in ST-Segment Elevation Myocardial Infarction – JAMA Internal Medicine (free for a limited period)

Aldosterone antagonists are beneficial for patients with STEMI and reduced ejection fraction. This meta-analysis suggests that patients with STEMI and LVEF greater than 40% or without heart failure also have improved outcomes with aldosterone antagonists.

 


Dose Increase Versus Unchanged Continuation of Antidepressants After Initial Antidepressant Treatment Failure in Patients With Major Depressive Disorder: A Systematic Review and Meta-Analysis of Randomized, Double-Blind Trials – The Journal of Clinical Psychiatry (link to abstract – $ for full-text)

Commentary: Depression: boosting SSRIs doesn’t work – Univadis (free registration required)

“Meta-analysis: there is evidence from RCTs against increasing the dose of SSRIs (with the possible exception of citalopram) in adult patients with major depression and antidepressant treatment failure” (via @psychopharmacol see Tweet)

 


ASCO 2018: Shortening Adjuvant Trastuzumab to 6 Months in Patients With HER2-Positive Early Breast Cancer Is Effective and Reduces Cardiac Toxicities – The ASCO Post (free)

Commentaries: Test of Herceptin Finds Briefer Treatment Can Work, With Fewer Side Effects – NPR (free) AND Shorter drug treatment OK for many breast cancer patients – Associated Press (free) AND For Women With Early Breast Cancer, Herceptin Treatment Can Be Much Shorter – The New York Times (10 articles per month are free)

““For women with early-stage breast cancer who needed the drug Herceptin, 6 months of treatment were as good as 12, a major study found. Less risk of side effects, less cost, less time “being a patient.”” (via @NYTHealth see Tweet)

 


Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents – assessment of adverse events in non-randomised studies – Cochrane Library (link to abstract – $ for full-text)

Summary: Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents – assessment of harmful effects – Cochrane Library (free)

“Our findings suggest that methylphenidate may be associated with a number of serious adverse events as well as a large number of non-serious adverse events in children and adolescents, which often lead to withdrawal of methylphenidate”.

 



Anticholinergic drugs and risk of dementia: case-control study – The BMJ (free)

Editorial: Anticholinergic drugs and dementia in older adults (free)

Commentaries: Expert reaction to study investigating the association between different types of anticholinergic drugs and risk of dementia – Science Media Centre (free) AND Anticholinergic drugs may be linked to increased risk of dementia – OnMedica (free)

“The effect of anticholinergic therapy is relatively small (odds ratio 1.1 – 1.2) and establishing an association does not prove a causal link. Nevertheless, the paper may act as a useful guide for future research and clinical practice”. (by Prof Les Iversen, in Science Media Centre)

 


First-line drugs for hypertension – Cochrane Library (free)

Summary: Thiazides best first choice for hypertension – Cochrane Library (free)

“First-line low-dose thiazides reduced all morbidity and mortality outcomes in adult patients with moderate to severe primary hypertension. First-line ACE inhibitors and calcium channel blockers may be similarly effective, but the evidence was of lower quality”.

 


Acid‐suppressive drugs and risk of kidney disease: A systematic review and meta‐analysis – Journal of Gastroenterology and Hepatology (link to abstract – $ for full-text)

Source: Hospital Medicine Virtual Journal Club

Proton pump inhibitors were associated with higher risks of acute interstitial nephritis (HR, 2.78; 95% CI, 1.25‐6.17), acute kidney injury (HR, 1.85; 95% CI, 1.33‐2.59), chronic kidney disease (HR, 1.47; 95% CI, 1.03‐2.09), and end‐stage renal disease (HR, 1.61; 95% CI, 1.26‐2.04) than non‐PPI therapy. Similar risks were not identified for H2RA therapy.

 


When antibiotics turn toxic – Nature News (free)

“Commonly prescribed drugs called fluoroquinolones cause rare, disabling side effects. Researchers are struggling to work out why”.

 


A Quiet Drug Problem Among the Elderly – The New York Times (free)

Related: Our Other Prescription Drug Problem – New England Journal of Medicine (free) AND Benzodiazepines: our other prescription drug epidemic – STAT (free)

“Despite warnings from experts, older people are using more anti-anxiety and sleep medications, putting them at risk of serious side effects and even overdoses”.

 


Do Antidepressants Work? – The New York Times (10 articles per month are free)

“The most comprehensive study on them has recently been published, showing mostly modest effects”.

See related meta-analysis and commentaries in our February 23rd issue (see #3)

 


#ACC18 – The ODYSSEY Trial Ends Well— But Will It Be Enough? – Cardiobrief (free) AND Ten Quick Thoughts on ODYSSEY – John Mandrola, via Medscape (free registration required)

“An absolute risk reduction of 1.6% in the primary endpoint translates to a number needed to treat of 64. Using the current price of $14,500 per year, Kaul calculated that preventing one event over the trial period of almost 3 years would cost about $2.6 million” (via John Mandrola). This study was presented at #ACC18 and has not been published yet. Among the many commentaries, these two were selected for a balanced point of view.

 


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