Pharmacology/Pharmaceutical Industry
M-A | Comparison of a short vs. long-course antibiotic therapy for ventilator-associated pneumonia
7 Mar, 2023 | 13:18h | UTCSummary:
This systematic review and meta-analysis of randomized controlled trials aimed to compare the rates of recurrence and relapse of ventilator-associated pneumonia (VAP) between short-course (≤8 days) and long-course (≥10-15 days) antibiotic therapy strategies. Five relevant studies involving 1069 patients were identified.
Compared to long-course therapy, short-course therapy increased the number of antibiotic-free days without any impact on recurrence and relapses of VAP, 28 days mortality, mechanical ventilation duration, number of extra-pulmonary infections, and length of ICU stay.
However, the study’s limitations, such as the small sample size and the lack of standardized definitions of the assessed outcomes, should be considered when interpreting the results.
Commentary: Study finds benefits in short-course antibiotics for ventilator-associated pneumonia – CIDRAP
Cohort Study | Early pregnancy exposure to NSAIDs is associated with slightly higher risks of neonatal and maternal adverse outcomes
7 Mar, 2023 | 12:56h | UTCSummary:
A nationwide cohort study in South Korea, including 1.8 million pregnancies, investigated the association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during early pregnancy and neonatal and maternal adverse outcomes.
The study revealed that pregnant women exposed to NSAIDs during early pregnancy were at increased risk of oligohydramnios and had a slightly higher likelihood of having an infant with major congenital malformations and low birth weight. These risks remained elevated when comparing NSAIDs against acetaminophen or past users.
The study suggests that clinicians should weigh the need to prescribe NSAIDs in early pregnancy against the modest but possible risk of neonatal and maternal outcomes and consider prescribing nonselective NSAIDs for <10 days, with continued careful monitoring for any safety signals.
M-A | Oral iron supplementation and anemia in children according to schedule, duration, dose and cosupplementation
7 Mar, 2023 | 12:53h | UTCSummary:
The article is a systematic review and meta-analysis of 129 randomized trials on iron supplementation and anemia in children. The study aimed to identify the optimal schedule, duration, dose, and cosupplementation regimen for iron supplementation in children and adolescents aged under 20 years.
The results showed that frequent (3-7 times/week) and intermittent (1-2 times/week) iron supplementation could be equally effective at increasing hemoglobin and decreasing anemia, iron deficiency, and iron deficiency anemia.
The study supports WHO recommendations regarding the frequency, duration, and dose of iron supplementation, including 3 months annually of daily oral iron supplementation for children aged 6 months to 12 years living in regions with a high burden of anemia. However, it also suggests that weekly iron supplementation might be considered an alternative to the recommended daily regimen in some contexts, given evidence of similar efficacy.
Review | Analysis of deprescription strategies of proton pump inhibitors in primary care
7 Mar, 2023 | 12:42h | UTCRelated:
Deprescribing proton pump inhibitors – Australian Journal of General Practice
An overview of systematic reviews and meta-analyses on the effect of medication interventions targeting polypharmacy for frail older adults
3 Mar, 2023 | 14:07h | UTCSummary: This overview of published systematic reviews examined the effectiveness of medication reviews on managing polypharmacy in frail older adults. The overview identified 10 systematic reviews, which included 154 studies. Medication reviews were the most common intervention, and the evidence suggests that they help reduce inappropriate medication use in frail older adults, but their impact on frailty scores and hospital admission is unclear. Pharmacist-led medication interventions were the most common, reducing inappropriate prescriptions in various settings. Tools, such as clinical decision-making computer support tools, were also found to be effective. The evidence quality ranged from moderate to critically low, highlighting the need for further research to establish if interventions directed at polypharmacy could have an impact on frailty syndromes.
Related:
RCT | A deprescribing intervention reduced medication burden among older adults in post-acute care
Deprescribing proton pump inhibitors – Australian Journal of General Practice
Antihypertensive Deprescribing in Older Adults: a Practical Guide – Current Hypertension Reports
Deprescribing in Palliative Cancer Care – Life
Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review – Kidney360
Polypharmacy Management in Older Patients – Mayo Clinic Proceedings
Eliminating Medication Overload: A National Action Plan – Lown Institute
Common ED Medication Errors: Polypharmacy – emDocs
Current and future perspectives on the management of polypharmacy – BMC Family Practice
Polypharmacy—an Upward Trend with Unpredictable Effects – Deutsches Ärzteblatt international
Clinical Consequences of Polypharmacy in Elderly – Expert Opinion on Drug Safety
RCT | Physician-led medication reviews in polypharmacy patients with Type 2 DM treated with at least 12 medications
1 Mar, 2023 | 13:36h | UTC
M-A | Which adverse events and which drugs are implicated in drug-related hospital admissions
28 Feb, 2023 | 13:59h | UTCSummary: This systematic review and meta-analysis aimed to provide an updated estimation of drug-related hospital admissions, the types and frequency of drug-induced harm, and the drugs involved. The review included 17 studies that examined acute admissions to emergency departments or inpatient wards resulting from drug-induced harm in the general population. These studies were published between January 2012 and December 2021. The estimated rates of admissions resulting from adverse drug reactions* (ADRs) and adverse drug events* (ADEs) were 8.3% and 13.9%, respectively. Almost half of the admissions related to ADRs and over two-thirds of those related to ADEs were possibly preventable. Gastrointestinal disorders, electrolyte disturbances, bleeding events, and renal and urinary disorders were the most frequently involved categories of drug-induced harm. The most frequently involved drug groups were nervous system drugs, followed by cardiovascular and antithrombotic agents.
*Adverse drug events (ADEs) and adverse drug reactions (ADRs) are two terms that are often used interchangeably, but they actually have different meanings. Adverse drug events (ADEs) refer to any negative effect that results from medication exposure and can be caused by a variety of factors, including medication errors, overdose, drug interactions, or allergic reactions. In contrast, adverse drug reactions (ADRs) are a specific type of ADE that occur as unintended effects of medication at normal therapeutic doses.
Cluster RCT | Effect of an antibiotic stewardship intervention to improve antibiotic prescribing for suspected UTI in older adults
24 Feb, 2023 | 13:58h | UTCSummary: The study evaluated the effectiveness of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections (UTI) in frail older adults. The study was a pragmatic, parallel, cluster-randomized controlled trial conducted in four European countries and included 1041 frail older adults aged 70 or older. The intervention involved a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. The control group provided care as usual. The primary outcome was the number of antibiotic prescriptions for suspected UTI per person year, and secondary outcomes included incidence of complications, hospital referrals, admissions, and mortality. The results showed that the intervention group had a lower rate of receiving an antibiotic prescription for a suspected UTI (0.27 per person year) compared to the control group (0.58 per person year), with no increase in complications or adverse events.
Commentary: Trial: Stewardship intervention cuts antibiotic prescribing for suspected urinary infections – CIDRAP
Related:
Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
Acute pain management pearls: a focused review for the hospital clinician
23 Feb, 2023 | 13:15h | UTCAcute Pain Management Pearls: A Focused Review for the Hospital Clinician – Healthcare
Antibiotic allergy de-labeling: a pathway against antibiotic resistance
23 Feb, 2023 | 13:12h | UTCAntibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance – Antibiotics
Related:
M-A: Most patients with allergy to Penicillin can be given Cefazolin
Podcast: A Clinical Pharmacologist’s Perspective on Penicillin Allergy
Study: Development and Validation of a Penicillin Allergy Clinical Decision Rule
NICE: Double Check Patients with ‘Penicillin Allergy’ to Avoid Increased MRSA Risk
Perspective | Application of Bayesian approaches in drug development: starting a virtuous cycle
22 Feb, 2023 | 12:32h | UTC
Commentary on Twitter
Application of Bayesian approaches in drug development: starting a virtuous cycle https://t.co/GxPFRA3J6u
A new Perspective that highlights the value of Bayesian methods in drug development, discusses barriers to their application and recommends approaches to address them pic.twitter.com/JTgo02aPdI
— Nature Reviews Drug Discovery (@NatRevDrugDisc) February 16, 2023
Analysis | High drug prices are not justified by industry’s spending on research and development
21 Feb, 2023 | 11:41h | UTCHigh drug prices are not justified by industry’s spending on research and development – The BMJ
News Release: Drug prices not justified by industry’s research and development spending – BMJ Newsroom
Commentary from the author on Twitter (thread – click for more)
New @bmj_latest paper?
High drug prices do not seem justified by pharma industry’s R&D spending & new drugs' added benefits ??
How can companies develop more innovative & affordable medicines?Read the thread ?https://t.co/YYznD4Tvwq@ojwouters @ElsTorreele @martinmckee
— Aris Angelis (@Aris_Angelis) February 16, 2023
Study finds low rates of antipsychotic medication discontinuation in older adults following infection-related hospitalization
20 Feb, 2023 | 12:25h | UTCSummary: The study aimed to investigate discontinuation rates of antipsychotic medications (APMs) used to treat delirium due to acute hospitalization and infection in older adults. The cohort study involved 5,835 patients in the US, who were aged 65 years or older, without prior psychiatric disorders and had newly initiated an APM prescription within 30 days of an infection-related hospitalization. The study found that only 11% of new atypical APM users and 52% of new haloperidol users discontinued the medication by 30 days after initiation. The discontinuation of haloperidol and atypical APM was less likely to occur in patients with dementia and prolonged hospitalization. The findings suggest that APM discontinuation rates following infection-related hospitalization are low, especially for atypical APM, and call for effective interventions to proactively discontinue APMs when they are no longer indicated.
SR | Antipsychotic exposure is an independent risk factor for breast cancer
17 Feb, 2023 | 12:41h | UTC
Acute pain management pearls: a focused review for the hospital clinician
17 Feb, 2023 | 12:42h | UTCAcute Pain Management Pearls: A Focused Review for the Hospital Clinician – Healthcare
M-A | Association between antimicrobial stewardship programs and antibiotic use globally
16 Feb, 2023 | 15:21h | UTCCommentaries:
Antimicrobial Stewardship Programs Beneficial for Cutting Antibiotic Use – HealthDay
M-A | Worldwide prevalence of antibiotic-associated Stevens-Johnson syndrome and toxic epidermal necrolysis
16 Feb, 2023 | 15:04h | UTCSummary: The article examined the prevalence Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) associated with antibiotics worldwide. The analysis included 38 studies involving 2,917 patients, which showed that 28% of SJS/TEN cases were associated with antibiotics. Among antibiotic-associated SJS/TEN, the sulfonamide class was associated with 32% of cases, followed by penicillins, cephalosporins, fluoroquinolones, and macrolides.
Article: Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Meta-analysis – JAMA Dermatology (free for a limited period)
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.
Guideline Synopsis | The use of opioids in the management of chronic pain
15 Feb, 2023 | 16:16h | UTCSummary: The VA/DoD guideline for chronic pain management recommends non-opioid treatments, such as cognitive-behavioral and physical therapy, with opioid use reserved for specific circumstances. Mental health evaluations are emphasized, along with regular treatment reassessments. Opioid use is not recommended due to small benefits outweighed by risks, but if used, buprenorphine is suggested due to a lower risk profile. Screening for mood disorders and traumatic brain injury is also advised, although evidence for risk mitigation strategies is lacking.*
Commentary: Initiation of Opioids Not Recommended for Chronic Pain – HealthDay
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.
Cohort Study | In utero exposure to ADHD medication does not seem to result in worse offspring neurodevelopmental outcomes
14 Feb, 2023 | 10:54h | UTCSummary: The authors conducted a study to investigate the long-term effects of in utero exposure to ADHD medication (methylphenidate, amphetamine, dexamphetamine, lisdexamphetamine, modafinil, atomoxetine, clonidine) on offspring. The study followed 1,068,073 liveborn singletons from 1998 to 2018 and compared the outcomes of children whose mothers continued or discontinued ADHD medication during pregnancy. The main outcomes were neurodevelopmental psychiatric disorders, impairments in vision or hearing, epilepsy, seizures, or growth impairment during childhood or adolescence. After adjustment for demographic and psychiatric characteristics of the mother, no increased risk of any developmental disorders was found in offspring exposed to ADHD medication compared to those not exposed. The results provide reassurance for women with ADHD who depend on medication and consider continuing it during pregnancy.
(By ChatGPT, reviewed and edited)
Article: In utero exposure to ADHD medication and long-term offspring outcomes – Molecular Psychiatry (link to abstract – $ for full-text)
Commentary from the author on Twitter (thread – click for more)
In-utero exposure to ADHD medication is not associated with long-term adverse neurodevelopmental disorders and growth restriction in the offspring.
Read the thread below ?on our new paper just published in @molpsychiatry
? https://t.co/MKZ0aeFnhU#ADHD— Kathrine Bang Madsen (@Kathrine_BaMa) February 9, 2023
Recommended adult immunization schedule, United States, 2023
13 Feb, 2023 | 13:06h | UTCRecommended Adult Immunization Schedule, United States, 2023 – Annals of Internal Medicine
Commentary: Recommended 2023 Adult Immunization Schedule Published – HealthDay
Commentary on Twitter
The 2023 #ACIP schedule is out now with important changes to #COVID19 and pneumococcal vaccines, including recommendations for adults who have previously received PCV13 and PPSV23: https://t.co/QeErLZJFuZ pic.twitter.com/BR6aa1kNKi
— Annals of Int Med (@AnnalsofIM) February 10, 2023
Updated child and adolescent immunization schedule, United States, 2023
13 Feb, 2023 | 13:05h | UTCChild and Adolescent Immunization Schedule by Age – Centers for Diseases Control and Prevention
See also: Recommended Childhood and Adolescent Immunization Schedule: United States, 2023 – Pediatrics
Commentary: Immunization Schedule for Children, Teens Updated for 2023 – HealthDay
RCT | A deprescribing intervention reduced medication burden among older adults in post-acute care
13 Feb, 2023 | 12:50h | UTCDeprescribing Medications Among Older Adults From End of Hospitalization Through Postacute Care: A Shed-MEDS Randomized Clinical Trial – JAMA Internal Medicine (free for a limited period)
Related:
Deprescribing proton pump inhibitors – Australian Journal of General Practice
Antihypertensive Deprescribing in Older Adults: a Practical Guide – Current Hypertension Reports
Deprescribing in Palliative Cancer Care – Life
Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review – Kidney360
Polypharmacy Management in Older Patients – Mayo Clinic Proceedings
Eliminating Medication Overload: A National Action Plan – Lown Institute
Common ED Medication Errors: Polypharmacy – emDocs
Current and future perspectives on the management of polypharmacy – BMC Family Practice
Polypharmacy—an Upward Trend with Unpredictable Effects – Deutsches Ärzteblatt international
Clinical Consequences of Polypharmacy in Elderly – Expert Opinion on Drug Safety
Commentary on Twitter
A randomized trial of patient-centered #deprescribing in the acute care setting reduced medication burden by 14% among older hospitalized patients that needed ongoing post-acute care. https://t.co/FJf53O00Cv #ShedMEDS #polypharmacy #LessIsMore #Geriatrics
— JAMA Internal Medicine (@JAMAInternalMed) February 9, 2023
M-A | Prevalence of polypharmacy and potentially inappropriate medication use in older lung cancer patients
9 Feb, 2023 | 13:24h | UTC
Evaluation of a 12-gene pharmacogenetic panel to prevent adverse drug reactions
7 Feb, 2023 | 14:13h | UTCA 12-gene pharmacogenetic panel to prevent adverse drug reactions: an open-label, multicentre, controlled, cluster-randomised crossover implementation study – The Lancet (link to abstract – $ for full-text)
News Releases:
Matching medication to DNA leads to 30% fewer side effects – University of Liverpool
Genetic analysis can reduce adverse drug reactions by 30 per cent – Karolinska Institutet
Commentary from one of the authors on Twitter
A journey which started in 2016 has led to the publication of the #PREPARE study in @TheLancet today. In this #randomised study, we show that a 12-gene panel can reduce #adverse_effects by 30%. https://t.co/vj7gYzgxyf @CDSS_Liverpool @pandtuol pic.twitter.com/tjgFWDuTQf
— Munir Pirmohamed (@MPUoL) February 3, 2023
Cohort Study | The use of 5-alfa-reductase inhibitors may increase the risk of depression, but not dementia
7 Feb, 2023 | 13:35h | UTCAssociation of 5α-Reductase Inhibitors With Dementia, Depression, and Suicide – JAMA Network Open
Commentary: 5α-Reductase Inhibitors Linked to Depression, but Not Dementia – HealthDay