Concurrent Macrolide Antibiotic Associated With Statin Toxicity

266 (Photo credit: Wikipedia)

Ann. Intern. Med. 2013 Jun 01;158(12)869-876, AM Patel, S Shariff, DG Bailey, DN Juurlink, S Gandhi, M Mamdani, T Gomes, J Fleet, YJ Hwang, AX Garg

TAKE-HOME MESSAGE

A retrospective population-based cohort study of statin users > 65 years found that concurrent clarithromycin or erythromycin use with statins increases the risk of rhabdomyolysis, acute kidney injury, and all-cause mortality. Clinicians should consider prescribing alternative macrolides, or other antibiotic classes, when patients are taking statins.

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SUMMARY

PracticeUpdate Editorial Team

Background: Clarithromycin and erythromycin, but not azithromycin, inhibit cytochrome P450 isoenzyme 3A4 (CYP3A4), and inhibition increases blood concentrations of statins that are metabolized by CYP3A4.
Objective: To measure the frequency of statin toxicity after coprescription of a statin with clarithromycin or erythromycin.
Design: Population-based cohort study.
Setting: Ontario, Canada, from 2003 to 2010.
Patients: Continuous statin users older than 65 years who were prescribed clarithromycin (n = 72 591) or erythromycin (n = 3267) compared with those prescribed azithromycin (n = 68 478).
Measurements: The primary outcome was hospitalization with rhabdomyolysis within 30 days of the antibiotic prescription.
Results: Atorvastatin was the most commonly prescribed statin (73%) followed by simvastatin and lovastatin. Compared with azithromycin, coprescription of a statin with clarithromycin or erythromycin was associated with a higher risk for hospitalization with rhabdomyolysis (absolute risk increase, 0.02% [95% CI, 0.01% to 0.03%]; relative risk [RR], 2.17 [CI, 1.04 to 4.53]) or with acute kidney injury (absolute risk increase, 1.26% [CI, 0.58% to 1.95%]; RR, 1.78 [CI, 1.49 to 2.14]) and for all-cause mortality (absolute risk increase, 0.25% [CI, 0.17% to 0.33%]; RR, 1.56 [CI, 1.36 to 1.80]).
Limitations: Only older adults were included in the study. The absolute risk increase for rhabdomyolysis may be underestimated because the codes used to identify it were insensitive.

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Annals of Internal Medicine

Statin Toxicity From Macrolide Antibiotic Coprescription: A Population-Based Cohort Study

Ann. Intern. Med. 2013 Jun 01;158(12)869-876, AM Patel, S Shariff, DG Bailey, DN Juurlink, S Gandhi, M Mamdani, T Gomes, J Fleet, YJ Hwang, AX Garg

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U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for coronary heart disease (CHD).

38 Double Outlet Right Ventricle with ASD, VSD, bicuspid aortic (Photo credit: HeartBabyHome)

Description:

Update of the 2004 U.S. Preventive Services Task

Force (USPSTF) recommendation statement on screening for coro-

nary heart disease (CHD).

Methods:

The USPSTF reviewed new evidence on the benefits of

screening with electrocardiography (ECG) in asymptomatic adults to

reduce the risk for CHD events versus not screening, the effect of

identifying high-risk persons on treatment to reduce risk, the accu-

racy of stratifying individuals into risk categories, and the harms of

screening.

Recommendations:

The USPSTF recommends against screening

with resting or exercise ECG for the prediction of CHD events

in asymptomatic adults at low risk for CHD events (D

recommendation).

The USPSTF concludes that the current evidence is insufficient to

assess the balance of benefits and harms of screening with resting

or exercise ECG for the prediction of CHD events in asymptomatic

adults at intermediate or high risk for CHD events (I statement).

Ann Intern Med.

2012;157:512-518.

www.annals.org

For author affiliation, see end of text.

* For a list of the members of the USPSTF, see the

Appendix

(available at

www.annals.org).

This article was published at www.annals.org on 31 July 2012.

 http://www.uspreventiveservicestaskforce.org/uspstf11/coronarydis/chdfinalrs.pdf

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Guidelines from the USPTF: HIV Screening

English: Vectorized version of graph showing HIV viral load in relation to CD4+ lymphocyte count (Photo credit: Wikipedia)

Screening for HIV

U.S. Preventive Services Task Force Recommendation Statement

Release Date: April 2013
Clinical Summary : Recomendation A.

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This article was first published in Annals of Internal Medicine (Ann Intern Med 2013;30 Apr). Select for copyright and source information.

Contents

Summary of Recommendations and Evidence Rationale Clinical Considerations Other Considerations Discussion Update of Previous Recommendation Recommendations of Others Members of the Task Force References

Task Force Ratings Strength of Recommendations and Quality of Evidence

Summary of Recommendations and Evidence

The USPSTF recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened (A recommendation).
Go to the Clinical Considerations for more information about screening intervals.
The USPSTF recommends that clinicians screen all pregnant women for HIV, including those who present in labor who are untested and whose HIV status is unknown. (A recommendation)

Return to Contents

Rationale

Importance

An estimated 1.2 million persons in the United States are currently living with HIV infection, and the annual incidence of the disease is approximately 50,000 cases. Since the first cases of AIDS were reported in 1981, more than 1.1 million persons have been diagnosed and nearly 595,000 have died from the condition. Approximately 20% to 25% of individuals living with HIV infection are unaware of their positive status.

Detection

The USPSTF found convincing evidence that conventional and rapid HIV antibody tests are highly accurate in diagnosing HIV infection.

Benefits of Detection and Early Intervention

The USPSTF found convincing evidence that identification and treatment of HIV infection is associated with a markedly reduced risk for progression to AIDS, AIDS-related events, and death in individuals with immunologically advanced disease (defined as a CD4 count <0 .200="" 10="" sup="">9

cells/L). Adequate evidence shows that initiating combined antiretroviral therapy (ART) earlier (that is, at CD4 counts between 0.200 and 0.500 × 10⁹ cells/L)—when individuals are more likely to be asymptomatic and detected by screening rather than clinical presentation—is also associated with reduced risk for AIDS-related events or death. The USPSTF found convincing evidence that the use of ART is associated with a substantially decreased risk for transmission from HIV-positive persons to uninfected heterosexual partners. Convincing evidence also shows that identification and treatment of HIV-positive pregnant women dramatically reduces rates of mother-to-child transmission. The overall benefits of screening for HIV infection in adolescents, adults, and pregnant women are substantial.

Harms of Detection and Early Intervention

The USPSTF found convincing evidence that individual antiretroviral drugs, drug classes, and combinations are all associated with short-term adverse events; however, many of these events are transient or self-limited, and effective alternatives can often be found. Although the long-term use of certain antiretroviral drugs may be associated with increased risk for cardiovascular and other adverse events, the magnitude of risk seems to be small. The overall harms of screening for and treatment of HIV infection in adolescents, adults, and pregnant women are small.

USPSTF Assessment

The USPSTF concludes with high certainty that the net benefit of screening for HIV infection in adolescents, adults, and pregnant women is substantial. 

Before Prostate Cancer Screening, Men Should Know Harm Is More Likely Than Benefit

By Bridget M. Kuehn on April 8, 2013

Men should know that they are more likely to be harmed than to benefit from prostate cancer screening and should only be screened if they have a strong preference for screening, a new guideline states. Image: scibak/iStockphoto.com

Men should be fully informed that they’re unlikely to benefit from prostate cancer screening and may face a substantial risk of various harms, such as complications from biopsy or treatment that may include infection, incontinence, or impotency, according to a new guideline from the American College of Physicians (ACP) published today in the Annals of Internal Medicine.
One in 6 men will be diagnosed as having prostate cancer in his lifetime, but only 3 of 100 men who are diagnosed as having the disease will die of it, according to the guideline. In other words, 97 of 100 men with prostate cancer will die of some other cause. In addition, most men who die of prostate cancer are older than 75 years. Yet despite the low risk of death from prostate cancer, especially among younger men, screening—using either the prostate-specific antigen (PSA) tests or a digital rectal examination—continues to be commonplace.
Thus, the likelihood of a man benefiting from prostate cancer screening is quite limited; about 1000 men would have to be screened to save 1 life, the guideline notes. Harm resulting from testing, however, is far more common. The false-positive rate for these tests is high and men who receive a positive result may undergo further invasive tests, such as a prostate biopsy, which can lead to infection, bleeding, or hospitalization. In addition, men who are diagnosed as having prostate cancer are likely to undergo radiation or surgery. Prostate cancer surgery is associated with a small increased risk of death, a 37% increased risk of sexual dysfunction, and an 11% increased risk of urinary incontinence.
Based on these risks and the fact that few men are likely to benefit, the US Preventive Services Task Force has recommended against prostate cancer screening with the PSA test. Other guidelines reviewed by the ACP as part of their own guideline-producing process recommend that physicians talk with patients about the risks and the patient’s preferences.
The ACP recommends that physicians fully inform patients aged 50 to 69 years that they are unlikely to benefit and face a substantial risk of harm from prostate cancer screening. The group also says that screening with the PSA test should be carried out only after such disclosure has occurred and the patient has expressed a clear preference for screening.
The authors conclude that “each man should have the opportunity to decide for himself whether to have the PSA screening test.”
Moreover, the ACP advises against prostate cancer screening with a PSA test for men younger than 50 years, older than 69 years, or with a remaining life expectancy of less than 10 to 15 years.

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USPSTF: mujeres posmenopáusicas no deben tomar suplementos de calcio y vitamina D para prevenir las fracturas

Annals of Internal Medicine (Photo credit: Wikipedia)

coincidiendo con lo publicado  en el Australian Precriber, ayer se publico en la revista Annals of Internal Medicine  una recomendación del Preventive Services Task Force de los EE.UU señala que las mujeres posmenopáusicas no deben tomar calcio suplementario (1000 mg o menos) y vitamina D (400 UI o menos) para prevenir las fracturas. El grupo de trabajo dice que la suplementación con estas dosis no reduce el riesgo de fractura primaria, mientras que supone un pequeño aumento del riesgo de cálculos renales.

El grupo llegó a la conclusión de que no hay suficiente evidencia para hacer recomendaciones a favor o en contra de mayores dosis de calcio y vitamina D o para los hombres o las mujeres premenopáusicas.
 USPSTF: mujeres posmenopáusicas no deben tomar suplementos de calcio y vitamina D para prevenir las fracturas

El resumen del trabajo
Moyer VA on behalf of the U.S. Preventive Services Task Force* USPSTF. Vitamin D and Calcium Supplementation to Prevent Fractures in Adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2013 Feb 26. doi: 10.7326/0003-4819-158-9-201305070-00606. [Epub ahead of print]
26 de febrero 2013

Descripción: Nueva recomendación del EE.UU. Preventive Services Task Force (USPSTF) sobre los suplementos de vitamina D y calcio para prevenir las fracturas en los adultos.

Métodos: El USPSTF encargó dos revisiones sistemáticas y metanálisis de las evidencias sobre los suplementos de vitamina D con o sin calcio para evaluar los efectos de la suplementación en la salud ósea en los adultos residentes en la comunidad, la asociación de vitamina D y los niveles de calcio con los resultados de salud ósea , y los efectos adversos de la suplementación.

Población: Estas recomendaciones se aplican a los adultos asintomáticos no institucionalizados o de la comunidad sin antecedentes de fracturas. Esta recomendación no se aplica al tratamiento de las personas con osteoporosis o deficiencia de vitamina D.

Recomendación: La USPSTF concluye que la evidencia actual es insuficiente para evaluar el balance beneficio/riesgo de la combinación de suplementos de vitamina D y calcio para la prevención primaria de las fracturas en mujeres premenopáusicas o en hombres. (Declaración I)

La USPSTF concluye que la evidencia actual es insuficiente para evaluar el balance beneficio/riesgo de la suplementación diaria con más de 400 UI de vitamina D3 y más de 1000 mg de calcio para la prevención primaria de las fracturas en mujeres posmenopáusicas no institucionalizados. (Declaración I)

El USPSTF, NO recomienda la suplementación diaria con 400 UI o menos de la vitamina D3 y 1000 mg o menos de calcio para la prevención primaria de las fracturas en mujeres posmenopáusicas no institucionalizados. (Recomendación D)




Via: Martin Cañas - REDSAF.
 
Artículo completo disponible en http://annals.org/article.aspx?articleid=1655858

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Newspaper and reliable medical information

Public release date: 31-Jan-2012

Contact: Annmarie Christensen
annmarie.christensen@dartmouth.edu
603-653-0897
Dartmouth-Hitchcock Medical Center 

Quality medical journal news releases can help newspapers do a better job informing public

LEBANON, N.H. -- Medical journal press releases are the most direct way that journals communicate with the news media about new research. According to a study in the British Medical Journal, press release quality appears to have an important effect on the quality of subsequent newspaper stories. With high quality press releases, key information –basic study facts, quantification of results, acknowledgment of limitations – is substantially more likely to appear in newspaper stories. Low quality press releases, those omitting such key information, may actually make newspaper stories worse than if there were no press release at all.
"The news media matter: medical reporting not only educates but also influences health beliefs and behaviors," said Steven Woloshin and Lisa Schwartz, principal co-investigators of the study. "Our study shows that press releases are important as well."
The investigators, co-directors of the Center for Medicine and the Media at The Dartmouth Institute of Health Policy and Clinical Practice, reviewed consecutive issues of five major medical journals that frequently receive news coverage but have different editorial practices. Two of the journals (Annals of Internal Medicine, Journal of the National Cancer Institute) include editorial notes highlighting study cautions in the studies, two do not (JAMA, British Medical Journal), and one journal in the group does not issue press releases (New England Journal of Medicine).
The authors reviewed consecutive issues of each medical journal (going backwards from January 2009) to identify 100 original research articles that generated newspaper coverage. A total of 759 newspaper stories (a median of three per journal article) were identified through searches of news article databases, Lexis Nexis and Factiva. The investigators did not examine broadcast, web and social media platforms.
All associated medical journal press releases – a total of 68 – were identified using the press release database http://www.eurekalert.org. Two independent research assistants assessed the quality of journal articles, press releases, and a stratified random sample of associated newspaper stories by using a structured coding scheme for the presence of specific quality measures: basic study facts, quantification of the main result, harms and limitations. In their analyses, the authors took into account whether the quality measures were available in the associated abstract of the medical journal article.
Of the 343 newspaper stories analyzed, 71 percent reported on articles for which medical journals had issued press releases. Some 9 percent of stories quantified the main result with absolute risks when this information was not in the press release, 53 percent did so when it was in the press release, and 20 percent when no press release was issued.
Of the total analyzed, 133 stories reported on research describing beneficial interventions. Some 24 percent mentioned harms (or specifically declared no harms) when harms were not mentioned in the press release; 68 percent when mentioned in the press release; and 36 percent when no press release was issued.
Some 256 stories reported on research with important limitations. Of these, 16 percent reported any limitations when limitations were not mentioned in the press release; 48 percent when mentioned in the press release, and 21 percent if no press release was issued.
The Dartmouth Institute investigators reported several limitations of their own study. They noted that since they did not conduct a randomized trial, it is possible that other factors besides the press release accounted for newspaper story quality. For example, medical journals that issue high quality press releases might take other steps that improve subsequent newspaper coverage (but they found no evidence for this). Other limitations: only newspaper print articles were analyzed even though web-based media is gaining in impact; subjectivity is inherent in any content analysis; and the investigators could have introduced bias in their use of stratified random sampling to select newspaper stories.
"Media coverage of medical research often fails to provide the information needed for the public to understand the findings and to decide whether to believe them. Although it is easy to blame journalists for poor quality reporting, problems with coverage could begin with the journalists' sources."
The investigators concluded that high quality press releases are a simple way for medical journals to increase the chance of newspapers reporting key information.
There is substantial room for improving press releases, the investigators noted. They believe medical journals should make the effort to do better and use press releases not simply to make medical news but to make news reporting better.

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Editor's Note: Please see the article http://www.bmj.com/content/344/bmj.d8164 for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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