Insecticide-Treated mosquito Bed Nets Linked to Reduction in Burkitt Lymphoma Incidence: JAMA

Researchers have found that the large-scale rollout of insecticide-treated bed nets (ITNs) in sub-Saharan Africa during the 2000s is associated with a significant reduction in the incidence of Burkitt lymphoma (BL) among children. According to a systematic review and meta-analysis published in JAMA Network Open by Nora S. this important finding highlights an additional benefit of malaria control programs in the region.

Burkitt lymphoma (BL) is one of the most common childhood cancers in sub-Saharan Africa and has been etiologically linked to malaria. However, limited evidence has been available to demonstrate the impact of malaria interventions on BL incidence. The systematic review and meta-analysis aimed to investigate the potential association between the large-scale rollout of ITNs in sub-Saharan Africa and the incidence of BL in children aged 0 to 15 years.

The study involved a systematic review of epidemiological studies on BL incidence rates in children and adolescents in sub-Saharan African countries where malaria is endemic. Researchers searched the Embase, Global Health, and Medline databases, as well as cancer registry publications, to identify studies published between January 1, 1990, and February 27, 2023. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

Data were extracted independently by two reviewers, and the quality of studies was assessed based on predefined criteria: data collection, case ascertainment, and calculation of person-time at risk. The main outcomes and measures included the incidence rates of BL during childhood and mean ITN use in the population. Data were analyzed using a random-effects negative binomial regression model.

The key findings of the study were:

  • Of the 2,333 studies meeting selection criteria, 23 studies comprising 66 data points on BL incidence were included in the analysis.

  • The studies were based on 5,226 BL cases from locations with large-scale ITN use across 17 countries.

  • The incidence rates of BL were found to be 44% (95% CI, 12%-64%) lower in the period after ITN introduction compared to before.

  • The adjusted pooled incidence rates of BL were 1.36 (95% CI, 0.88-2.10) and 0.76 (95% CI, 0.50-1.16) per 100,000 person-years before and after ITN introduction, respectively.

  • After adjusting for potential confounders, a 1-percentage point increase in mean ITN use in the population in the 10 years prior to BL data collection was associated with a 2% (95% CI, 1%-4%) reduction in BL incidence.

The systematic review and meta-analysis provide evidence that the large-scale rollout of ITNs in the 2000s is associated with a reduction in BL burden among children in sub-Saharan Africa. This study underscores the importance of malaria control programs and their potential to impact broader health outcomes in the region.

Reference:

Schmit, N., Kaur, J., & Aglago, E. K. (2024). Mosquito bed net use and burkitt lymphoma incidence in sub-Saharan Africa: A systematic review and meta-analysis. JAMA Network Open, 7(4), e247351. https://doi.org/10.1001/jamanetworkopen.2024.7351

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Increased mammographic breast density associated with cancer recurrence, suggests study

A new study from the Malmö Diet and Cancer Study revealed significant findings that could transform the way breast cancer survivors are monitored post-treatment. The findings were published in the recent edition of The Breast journal.

Breast cancer remains a major health challenge throughout the globe, with ongoing research focusing on how to better predict and prevent recurrences. This study spanned from 1991 to 2014 and focused at mammographic features such as breast density, tumor appearance and mode of detection, along with tumor size, axillary lymph node involvement and histological grade to understand their impact on recurrence-free survival (RFS).

The study analyzed data from a total of 1,082 women who were treated for invasive breast cancer by discovering that the individuals with higher breast density at the time of diagnosis were more likely to experience cancer recurrence. The findings indicate that women with high breast density are at a increased risk of recurrence with a adjusted hazard ratio of 1.32. This risk almost doubled to an adjusted hazard ratio of 2.12 among women whose breast cancer was initially detected through screening.

The analysis excluded 34 women due to metastatic disease at diagnosis or incomplete data and utilized Cox regression methods to establish these associations by providing a clear picture of how mammographic features can impact breast cancer outcomes. Also, no direct association between the mammographic appearance of the tumor and recurrence was observed.

The study highlighted the importance of these findings to identify the links between mammographic features and breast cancer recurrence can significantly aid in designing patient specific follow-up strategies for survivors which could potentially lead to earlier detection of recurrences.

The outcomes of this research underline the need for personalized surveillance strategies that consider individual mammographic features at diagnosis. Through this process, it may be possible to improve the long-term outcomes for breast cancer survivors for the individuals who were identified at higher risk due to their breast density.

Healthcare professionals and policymakers are hopeful that these insights will lead to more effective follow-up care protocols that can help in reducing the rate of breast cancer recurrence and improve survival rates. Overall, this study is a step forward in the breast cancer management by offering potential to enhance the survivorship care plans based on more personalized data.

Reference:

Lång, K., Sturesdotter, L., Bengtsson, Y., Larsson, A.-M., & Sartor, H. (2024). Mammographic features at primary breast cancer diagnosis in relation to recurrence-free survival. In The Breast (p. 103736). Elsevier BV. https://doi.org/10.1016/j.breast.2024.103736

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Cyproheptadine-prazosin combo can reduce drinking in people with alcohol use disorder

A recent study published in the Addiction journal unveiled promising results for treating severe alcohol use disorder (AUD) using a combination of two medications, prazosin and cyproheptadine. This approach targets the α1b and 5HT2A receptors which demonstrated a significant reduction in alcohol consumption among participants.

This phase 2, double-blind, placebo-controlled study was conducted across 32 addiction treatment centers in France and involved a total of 154 participants who were diagnosed with severe AUD. This diverse group included 108 men and 46 women who were all rigorously selected to partake in this research.

The participants were divided into three groups for the three-month treatment duration. The low-dose group (LDG) received 8 mg of cyproheptadine and 5 mg of prazosin in extended-release form daily, while the high-dose group (HDG) was administered 12 mg of cyproheptadine and 10 mg prazosin daily. The control group received a placebo. The primary objective was to observe the change in total alcohol consumption (TAC) from the outset of the trial to the end of the three months.

The results found that both the LDG and HDG showed a significant decrease in TAC when compared to the placebo group, with the HDG demonstrating the most pronounced reduction. The HDG reduced their daily alcohol intake by an impressive 23.6 grams, while the LDG saw a reduction of 18.4 grams. These results were statistically significant and suggest that increased doses of the medication combination may lead to greater reductions in alcohol consumption. The subgroup of participants with very high-risk drinking levels (over 100 grams per day for men and over 60 grams per day for women) found the HDG to show an even more significant decrease in daily drinking by 29.8 grams.

Both medication doses were reported to be well-tolerated by participants by displaying similar safety profiles which are crucial for the treatment of chronic conditions such as AUD. This favorable safety profile combined with the efficacy of the treatment, marks a major step towards the management of alcohol dependence. Overall, these findings provide hope for the individuals with severe alcohol use disorder and contribute to the understanding of the complex neurobiology of addiction.

Source:

Aubin, H., Berlin, I., Guiraud, J., Bruhwyler, J., Batel, P., Perney, P., Trojak, B., Bendimerad, P., Guillou, M., Bisch, M., Grall‐Bronnec, M., Labarrière, D., Delsart, D., Questel, F., Moirand, R., Bernard, P., Trovero, F., Pham, H. P., Tassin, J., & Puech, A. (2024). Prazosin and cyproheptadine in combination in the treatment of alcohol use disorder: A randomized, double‐blind, placebo‐controlled trial. In Addiction. Wiley. https://doi.org/10.1111/add.16484

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Innovative Gastric Cancer Screening Approach Shows Promising Results in Randomized Controlled Trial

In a groundbreaking randomized controlled trial conducted in
Yurihonjo and Nikaho city, Akita Prefecture, researchers have unveiled a new
approach to gastric cancer (GC) screening that could revolutionize early
detection and treatment outcomes. The study compared the efficacy of two
screening methods, Ba-Endo (barium photofluorography following upper
gastrointestinal endoscopy) and ABC-Endo group (upper gastrointestinal
endoscopy according to serological stratification) and found that gastric
cancers could be better cured by endoscopic resection alone in
the ABC-Endo group.

The study results were published in the journal
Gastrointestinal Endoscopy.

Attempts have been undertaken to create an endoscopic
screening system that integrates serological gastric cancer (GC) risk
stratification, specifically the ABC classification, in conjunction with the
yearly population-based GC screening using barium. The study, spanning five
years and involving 1,206 participants, compared the efficacy of two screening
methods: the Ba-Endo group, which underwent annual barium tests followed by
detailed endoscopic examinations, and the ABC-Endo group.

The participants were carefully randomized using the
minimization method, with sex and age considered as key allocation factors.
Over the course of the study, the Ba-Endo group adhered to annual barium tests,
while the ABC-Endo group underwent esophagogastroduodenoscopy (EGD) at varying
intervals, including Group A (EGD only at entry), Group B (EGD once every 3
years), Group C (EGD once every 2 years), and Group D (EGD every year).


Findings:


  • Results from the trial revealed that both groups exhibited a
    similar overall GC detection rate of 1.9%, with 24 detected GC lesions.

  • The Ba-Endo and ABC-Endo groups demonstrated detection rates
    of 2.0% and 1.8%, respectively, showing no statistically significant
    differences between them (P=1.0).

  • However, a remarkable finding emerged when analyzing the
    efficacy of endoscopic resection in treating the detected GCs.


  • Notably, the study found that the rate of GCs cured by
    endoscopic resection alone was 41.6% in the Ba-Endo group. Surprisingly, the
    ABC-Endo group displayed a significantly higher rate, reaching 90.9% (P=0.02).

  • This groundbreaking outcome suggests that the ABC-Endo
    approach, which tailors endoscopy intervals based on individual risk factors,
    holds substantial promise in identifying and successfully treating GCs through
    less invasive means.


These results could potentially reshape the landscape of
gastric cancer screening programs worldwide. The personalized ABC-Endo strategy
not only demonstrated comparable detection rates to the traditional Ba-Endo
method but also exhibited a clear advantage in terms of successful endoscopic
resection, offering patients a less invasive and more effective treatment
option for early-stage gastric cancers. Further research and validation are
crucial, but the promising outcomes of this trial suggest a step forward in the
ongoing fight against gastric cancer.

Further reading: Kusano C, Gotoda T, Ishikawa H, Suzuki S, Ikehara H, Matsuyama Y. Gastric Cancer Detection Rates using Gastrointestinal Endoscopy with Serological Risk Stratification: A Randomized Controlled Trial. Gastrointest Endosc. Published online January 23, 2024. doi: 10.1016/j.gie.2024.01.022

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Vasomotor symptoms closely associated with low BMD in postmenopausal women

A recent study published in the recent edition of Osteoporosis International journal highlight the relationship between vasomotor symptoms (VMS) and bone health in peri- and postmenopausal women. Vasomotor symptoms includes hot flashes, night sweats and have long been recognized as common and distressing experiences for the women who transition through menopause.

The study was conducted by the team of Panagiotis Anagnostis who systematically reviewed and meta-analyzed the existing evidence to investigate the association of VMS with fracture risk and bone mineral density (BMD). The findings were derived from a comprehensive analysis of twenty studies that involved nearly 50,000 women and provide valuable insights into this previously underexplored area.

The outcomes of this research revealed that while VMS did not significantly increase the risk of fractures in postmenopausal women, they were strongly associated with low BMD which is a key indicator of bone health. Specifically, the women who experienced VMS were found to have a 54% increased likelihood of having low BMD when compared to the individuals without such symptoms. This association was more pronounced in the lumbar spine with a significant decrease in BMD observed.

Importantly, the conclusions of this study remained consistent even after accounting for factors such as the severity of VMS, age and study design. Furthermore, the association between VMS and low BMD persisted when the analysis was limited to the studies that excluded the use of menopausal hormone therapy by indicating the robustness of the findings.

Overall, the findings of this study have significant outcomes for the management of the postmenopausal health in women. While VMS may not directly increase the fracture risk, their association with reduced BMD illuminates the importance of addressing these symptoms early on to reduce the potential long-term effects on bone health.

These studies continue to look deeper into the complex interplay between menopause-related symptoms and the various aspects of women’s health that contribute to the valuable evidence which can guide the clinical practice and improve the quality of life for postmenopausal women. The findings underline the need for holistic approaches to menopausal care that prioritize both symptomatic management and the preservation of bone health.

Source:

Anagnostis, P., Lallas, K., Pappa, A., Avgeris, G., Beta, K., Damakis, D., Fountoukidou, E., Zidrou, M., Lambrinoudaki, I., & Goulis, D. G. (2024). The association of vasomotor symptoms with fracture risk and bone mineral density in postmenopausal women: a systematic review and meta-analysis of observational studies. In Osteoporosis International. Springer Science and Business Media LLC. https://doi.org/10.1007/s00198-024-07075-8

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The Timing and Patterns of Drinking During Pregnancy also Linked to Varying Effects on Fetal and Child Development: Study

When and how mothers drink alcohol during pregnancy has major implications for fetal and child development, according to two new studies in Alcohol: Clinical & Experimental Research. The effects of prenatal alcohol exposure (PAE) include stillbirth, preterm delivery, and fetal alcohol spectrum disorder (FASD). In US schools, 2–5% of children have FASD, which is linked to impaired growth and development, including cognitive function.

Most studies on PAE and FASD involve birthing parents whose alcohol use was chronic and heavy. Much less is known about what lower levels of drinking-a far more common circumstance-do to fetal development. In two US studies (which were conducted independently), researchers investigated the impacts of varying patterns of maternal alcohol consumption on fetal and developmental outcomes.

One team of researchers based in New Mexico worked with 281 mother-infant pairs. They assessed the birthing parent’s drinking behaviors in the weeks close to conception, before pregnancies become apparent, and through pregnancy. Using statistical analysis, they examined associations between drinking patterns, fetal growth, and gestational age at delivery. Another team examined data drawn from 2,227 people living in four US cities from grade school to early adulthood. This multi-site team used statistical analysis to explore the relationship between drinking frequency and the amount consumed per drinking occasion with measures of cognitive function in childhood, adolescence, and young adulthood.

Among the New Mexico participants, 84% of birthing parents reported at least one binge drinking episode during a month around their last menstrual period, when they averaged 14 drinks per week. During the second trimester, their alcohol consumption was much lower-approximately 1 drink per week – and reduced further to less than 1 drink per month in the third trimester. Earlier gestational age at delivery was related to the average amount of drinking per day during both the weeks close to conception and throughout pregnancy, as well as to mild-moderate PAE and binge drinking.

The amount of alcohol mothers consumed during pregnancy, specifically the maximum number of drinks in a 24-hour period, was also related to the reduced birth length percentile in newborns.In the multi-site study, the total amount of alcohol consumed by the mother during pregnancy correlated with a modest decline in her child’s cognitive function. However, when the frequency of drinking was considered separately from the amount drunk per occasion, the influences of different patterns of alcohol exposure were revealed.

The more complex model showed a contrast between children born to mothers who infrequently consumed less than three drinks per occasion (with virtually no effect on their cognitive function) and those whose mothers drank infrequently at higher levels (with a larger effect on their cognitive function). The amount consumed per occasion had the greatest effect on children born to women who drank at least twice a week. Among mothers who drank < 1 drink/occasion, frequency of drinking had virtually no effect, whereas when mothers drank moderate or large amounts/occasion, frequency of drinking was associated with dose-dependent declines in their children’s cognitive proficiency.

The New Mexico study underscores the impact of PAE very early in pregnancy and the impact of as little as one drink per week or less later in pregnancy on preterm delivery. The findings on infrequent high exposure in the multi-site study add to evidence of binge drinking as a key determinant of FASD impairment. These varying statistical approaches thus provide a more nuanced evaluation of drinking behaviors and their effects on fetal development.

Reference:

Jacobson JL, Akkaya-Hocagil T, Jacobson SW, Coles CD, Richardson GA, Olson HC, Day NL, Carter RC, Dodge NC, Dang KD, Cook RJ, Ryan LM. A dose-response analysis of the effects of prenatal alcohol exposure on cognitive development. Alcohol Clin Exp Res (Hoboken). 2024 Mar 30. doi: 10.1111/acer.15283.

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Desloratadine addition to isotretinoin regimen reduces pruritus in acne and improves patient satisfaction: AIIMS research

India: A recent study published in the International Journal of Dermatology has suggested the role of desloratadine, added to an isotretinoin regimen, in reducing disease and therapy-related pruritus in acne and results in improved patient satisfaction.

The study assessed outcomes in 75 patients with moderate to severe acne undergoing treatment with either low-dose oral isotretinoin plus desloratadine or isotretinoin alone. The researchers reported that both groups showed comparable improvements in acne severity at 12 weeks, however, the patients receiving low-dose isotretinoin with desloratadine 5 mg/day reported significantly lower pruritus rates and higher rates of satisfaction with treatment.

Neirita Hazarika, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India, and colleagues aimed to measure the effectiveness of oral isotretinoin with desloratadine versus oral isotretinoin alone in moderate to severe acne treatment at a tertiary care teaching hospital in North India.

The researchers enrolled 90 patients with moderate to severe acne to participate based on their fulfilling inclusion criteria in a randomized, assessor-blinded, parallel-arm study.

Using computer-generated tables, randomization was done to allocate treatments in a 1:1 ratio. A low-dose oral isotretinoin at 0.3 mg/kg/day with tab desloratadine at 5 mg/day was applied to the study group and compared with the same patients going without dosage when controls were conducted. The patients were followed up at 4, 8, and 12 weeks.

Following were the study’s key findings:

  • The primary outcome was an improved global acne grading system (GAGS) score and decreased acne lesion count.
  • Secondary outcome: patient satisfaction with treatment. The 90 participants were randomized and 15 participants dropped out of the study, leaving 75 participants for intention to treat analysis (n = 41, n = 30).
  • At week 12, the GAGS score and acne lesion count between the study and control groups were comparable.
  • Pruritus reported was 9.76% in the study versus 33.33% in the control group.
  • 53.66% of participants reported “excellent” treatment satisfaction in the study group versus 36.67% in the control group.

“In patients experiencing pruritus related to isotretinoin therapy, the addition of treatment with desloratadine, or alternative oral antihistamines, may increase compliance and patient satisfaction,” the researchers wrote.

Reference:

Hazarika, N., Yadav, P., Bagri, M., Chandrasekaran, D., & Bhatia, R. Oral isotretinoin with desloratadine compared with oral isotretinoin alone in the treatment of moderate to severe acne: A randomized, assessor-blinded study. International Journal of Dermatology. https://doi.org/10.1111/ijd.17129

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Increase in fasting blood sugar tied to higher risk of silent heart attack: Study

USA: Findings from a pooled analysis of four cohort studies support the significance of routine cardiac screening for subjects with elevated fasting glucose (FG), with and without diabetes.

The study, published in Cardiovascular Diabetology, higher longitudinal fasting glucose and larger intra-individual variability in FG over time were associated with a higher silent myocardial infarction (SMI) risk in a dose-response manner.

Silent myocardial infarction, characterized by the absence of typical symptoms such as chest pain, presents a formidable challenge in early detection and intervention. Often lurking beneath the surface, this stealthy assailant can exact a heavy toll on cardiovascular health, precipitating adverse outcomes and mortality. Against this backdrop, understanding the nuanced interplay between blood glucose dynamics and silent MI assumes paramount significance.

In the intricate tapestry of cardiovascular health, the role of blood glucose levels has emerged as a critical determinant, particularly concerning silent myocardial infarction. A groundbreaking pooled analysis of four cohort studies was conducted by Amy C. Alman, College of Public Health, University of South Florida, Tampa, FL, USA, and colleagues to investigate the longitudinal association between FG and silent MI and also delve into the nuanced aspect of dose-response.

For this purpose, the researchers analyzed data from 24,732 individuals from four prospective cohort studies, who were free of MI history at baseline. Average FG and intra-individual FG variability (coefficient of variation) were calculated, and SMI cases were identified using 12-lead ECG exams with the Minnesota codes and medical history. The average mean age of the study population was 60.5 years with a median fasting glucose of 97.3 mg/dL at baseline.

During the study’s follow-up period, FG was measured for each subject. A Cox regression model with time-dependent variables was applied to assess the association between FG and SMI after adjustment for gender, age, race, smoking, study, low-density lipoprotein level, longitudinal BMI, serum creatinine, and blood pressure.

Based on the study, the following inferences were made:

  • During an average of 9 years of follow-up, 357 SMI events were observed (incidence rate, 1.3 per 1000 person-years).
  • The association between FG and SMI was linear, and each 25 mg/dL increment in FG was associated with a 15% increase in the risk of SMI. This association remained significant after adjusting for using lipid-lowering medication, antidiabetic medication, antihypertensive medication, and insulin treatment (HR 1.08).
  • Higher average FG (HR per 25 mg/dL increase: 1.17) and variability of FG (HR per 1 sd increase: 1.23) over visits were also correlated with increased SMI risk.

In conclusion, increased longitudinal FG, average FG, and intra-individual variability of FG over time were all associated with an increased risk of silent MI during follow-up in this study population after adjusting for multiple confounders including medication use.

“Given the asymptomatic or atypical nature of SMI, these results emphasize routine cardiac screening, particularly for patients with elevated glucose, as a crucial approach for preventing silent myocardial infarction and promoting heart health,” the researchers concluded.

Reference:

Xiao, M., Malmi, M.A., Schocken, D.D. et al. Longitudinal blood glucose level and increased silent myocardial infarction: a pooled analysis of four cohort studies. Cardiovasc Diabetol 23, 130 (2024). https://doi.org/10.1186/s12933-024-02212-3

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Adding chemotherapy to hormone therapy helps control locally advanced prostate cancer: Study

For patients with locally advanced prostate cancer, combined treatment with chemotherapy and hormonal therapy offers extended control of prostate-specific antigen (PSA) levels, compared to hormonal therapy alone, reports a study in the April issue of The Journal of Urology®, an Official Journal of the American Urological Association (AUA). The journal is published in the Lippincott portfolio by Wolters Kluwer.

“Our clinical trial is the first to show a longer time to biochemical recurrence with chemotherapy plus standard hormone therapy for patients with locally advanced, high-risk prostate cancer,” comments Jiahua Pan of Shanghai Jiao Tong University, People’s Republic of China. “The findings add new evidence to support the use of combined chemohormonal therapy for a group of patients at high risk of recurrent, progressive prostate cancer.”

Chemohormonal therapy for high-risk, locally advanced prostate cancer

The randomized controlled trial included 141 men with locally advanced prostate cancer, in which cancer has spread outside the prostate to nearby tissues. All patients had clinical characteristics placing them at elevated risk of distant tumor spread (metastasis) after initial treatment.

In a 2:1 ratio, patients were randomly assigned to treatment with the chemotherapy agent docetaxel plus hormonal (androgen deprivation) therapy or hormonal therapy alone. In both groups, these “neoadjuvant” treatments were followed by surgery (radical prostatectomy and extended lymph node dissection).

The study focused on biochemical progression-free survival – control of serum PSA levels – as a sign of tumor control. Rising PSA levels are an early sign of recurrent or progressive prostate cancer. The study also looked at pathologic responses: whether the study treatments were effective in shrinking the prostate cancer before surgery.

Addition of chemotherapy prolongs time to rising PSA levels

Both groups had good pathologic responses: the cancer was “downstaged” before surgery in 65% of patients assigned to chemohormonal therapy and 48% of with hormonal therapy only. The two groups also had similar rates of minimal residual disease – only a small number of cancer cells remaining after treatment.

Chemohormonal therapy had a greater effect on biochemical progression-free survival. At three years’ follow-up, 29% of patients receiving chemotherapy plus hormonal therapy remained free of rising PSA levels, compared to 9.5% with hormonal therapy only.

Median time to rising PSA levels was 17 months with chemohormonal therapy versus 14 months with hormonal therapy alone. Patients receiving chemotherapy also had a higher treatment-free survival rate: 8.5% required no further prostate cancer treatment through five years’ follow-up. The two groups had similarly low complication and adverse event rates.

On its own, neoadjuvant hormonal therapy can improve tumor control in locally advanced prostate cancer, but studies have shown limited effects on patient survival. The combination of docetaxel chemotherapy and hormonal therapy has yielded inconsistent results, likely reflecting differences between studies.

The new study is the first to show improvement in biochemical recurrence rate with chemohormonal therapy in this group of patients. The results also point to possible improvements in other important outcomes.

The authors note that their study is limited by relatively short follow-up times – making it impossible to evaluate the effects on “more clinically significant endpoints,” including overall survival and risk of death due to prostate cancer. “Our study suggests that neoadjuvant docetaxel-based chemotherapy could bring significant improvement for patients,” the researchers write. They emphasize, “longer follow-up is needed for more supportive evidence.”

Reference:

Qian H, Chi C, Tricard T, Zhu Y, Dong L, Wang Y, Sha J, Wang J, Ma Z, Wang Y, Liu J, Dong B, Pan J, Xue W. A Prospective Randomized Trial of Neoadjuvant Chemohormonal Therapy vs Hormonal Therapy in Locally Advanced Prostate Cancer Treated by Radical Prostatectomy. J Urol. 2024 May;211(5):648-655. doi: 10.1097/JU.0000000000003876. 

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Antibiotics may not be effective against cough caused by Acute Lower Respiratory Tract Infections: Study

A recent study evaluates the effectiveness of antibiotics in treating acute lower respiratory tract infections (LRTI) among adult patients in US primary and urgent care settings. Antibiotic overuse remains common for LRTIs, despite evidence suggesting limited benefits and contributing to antibiotic resistance. This study aims to shed light on the impact of antibiotic use on symptom severity and treatment duration for LRTIs.

Researchers have found in a new study that Antibiotics may not be effective against cough caused by Acute Lower Respiratory Tract Infections.The study published in the Journal Of General Internal Medicine was conducted by Daniel J. and colleagues.

The study enrolled 718 adult patients presenting with cough and symptoms consistent with LRTI at primary or urgent care sites across the US. Data collected included demographics, comorbidities, symptoms, and respiratory pathogen testing. Severity of signs/symptoms was reported using diaries and text messages for up to 28 days. Antibiotic use and its effects on symptom duration and severity were analyzed.

The key findings of the study were as follows:

  • 29% of patients received antibiotics at baseline, with common prescriptions including amoxicillin-clavulanate, azithromycin, doxycycline, and amoxicillin.

  • Antibiotic use did not impact the duration or overall severity of cough, regardless of viral, bacterial, or mixed infections.

  • Patients receiving antibiotics were less likely to have a follow-up visit (14.1% vs 8.2%), but were more likely to receive systemic corticosteroids (31.9% vs 4.5%) and albuterol inhalers (22.7% vs 7.6%).

  • Patients believed antibiotics would shorten illness duration by nearly 4 days, despite evidence to the contrary.

The study highlights the limited effectiveness of antibiotics in treating acute LRTIs, with no measurable impact on symptom severity or duration. Moreover, patients’ unrealistic expectations regarding antibiotic efficacy underscore the importance of antibiotic stewardship efforts. Healthcare providers should prioritize educating patients on the appropriate use of antibiotics and managing expectations for LRTI treatment outcomes.

Antibiotics show no measurable impact on the severity or duration of cough due to acute LRTIs, according to a large prospective study in US primary and urgent care settings. Unrealistic patient expectations regarding antibiotic efficacy highlight the need for targeted antibiotic stewardship interventions to optimize treatment strategies and combat antibiotic resistance.

Reference

Merenstein, D.J., Barrett, B. & Ebell, M.H. Antibiotics Not Associated with Shorter Duration or Reduced Severity of Acute Lower Respiratory Tract Infection. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08758-y

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