Steroids rapidly reduce children’s croup symptoms and shorten hospital stays
Corticosteroids reduce symptoms of croup in children within two hours and continue to do so for at least 24 hours. They also cut the amount of time children spend in hospital by 15 hours and reduce return visits or readmissions from about 20% to 10%.
This Cochrane review assessed the effectiveness of corticosteroids such as dexamethasone and budesonide compared with placebo. It updates a previous review which concluded that corticosteroids reduce symptoms of croup at six hours.
The review also...
Joint infection after hip replacement is linked to some risk factors that could be modified
Ten years of National Joint Registry data show that many factors may increase the risk of joint infection following hip replacement. Less than 1 in 1,000 people on average needed revision surgery for infection per year.
Several modifiable patient factors increased risk, such as obesity and diabetes. Using ceramic components, and approaching surgery from the back rather than the side of the hip, may slightly reduce infection risk.
This NIHR-funded study analysed registry data for 623,253 hip re...
Tools for GPs can help reduce unnecessary antibiotic prescribing
Interventions to reduce inappropriate antibiotic prescribing for upper respiratory tract infections are most effective when they provide a negotiation tool to support patient interaction. These interventions are more likely to be rejected if they are perceived as interfering with individual clinical judgment or damaging patient relationships.
Upper respiratory tract infections often resolve themselves within a few days, without the need for antibiotics, yet antibiotics are often prescribed. Thi...
Ethanol locks in catheters for dialysis may prevent sepsis
In patients with tunnelled central venous catheters used for dialysis, ethanol locks may reduce catheter-related bloodstream infections when compared with other locks, mainly saline. There was no increase in the risk of catheter blockage with ethanol locks in this study.
Long-term catheters carry a risk of bloodstream infection. ‘Locks’ are the small amount of fluid left inside a long intravenous catheter between uses to reduce the risk of blockage with clotted blood and ideally als...
High-flow oxygen therapy may have a role in treating infants with more severe bronchiolitis
A randomised controlled trial of 1,472 infants with bronchiolitis found that more children improved when started on high-flow oxygen therapy than with standard oxygen therapy.
Those who failed to improve on standard therapy were switched to high flow oxygen. Most then improved - overall, similar numbers were transferred to intensive care. There was also no difference between the groups in the proportion of infants needing intubation, length of time on oxygen therapy or days spent in hospital.
Daily low-dose antibiotics halve urinary tract infections in people who self-catheterise
People who perform clean intermittent self-catheterisation can reduce symptomatic urinary tract infections from two per year to one by taking daily low-dose antibiotics.
This NIHR-funded trial randomised 404 adults in the UK who perform the procedure for a variety of reasons to either daily oral low-dose antibiotics or no prophylaxis. All had a recent history of urinary tract infection.
Although prophylactic antibiotics halved infection rates, it increased antimicrobial resistance compared wit...
Ultrasound shows potential for confirming the diagnosis of pneumonia in children
Ultrasound scans of the lungs can be more accurate than chest X-rays for diagnosing pneumonia in children in some circumstances.
A review of the published evidence found that lung ultrasound was more sensitive (missed fewer cases) and about as specific (gave about the same number of false alarms) as chest X-ray, when used to confirm suspected community-acquired pneumonia in children. While pneumonia is a clinical diagnosis, X-ray is often used for confirmation.
Ultrasound also spares the child...
Prescribing anti-inflammatories for urine infection reduces antibiotic use but increases complication risk
Urinary tract infection symptoms resolved by three days for 80% of women given antibiotics compared with 54% given anti-inflammatories. Anti-inflammatories reduced antibiotic use, but 5% of women developed more severe infection of the kidneys.
Urinary infections are the second most common reason for prescribing antibiotics in general practice, after respiratory infection. As such, this use may be contributing to increasing antibiotic resistance.
This Swiss trial provided an important head-to-h...
Vaccination likely to reduce influenza in healthy children
In healthy children aged two to 16, vaccines are likely to reduce laboratory-confirmed cases of influenza and may reduce the risk of influenza-like illness compared to placebo. Seven children need to receive the live vaccine to prevent one case of confirmed influenza. Twenty children need to be vaccinated to prevent one case of influenza-like illness.
This updated Cochrane review included 41 trials of either live attenuated (weakened) or inactivated influenza vaccines, with over 200,000 partici...
Probiotics can prevent bacterial diarrhoea in hospital patients receiving antibiotics
Giving probiotics to people taking antibiotics reduces the chance of them developing diarrhoea caused by Clostridium difficile (C. difficile) bacteria by 60%. One case of Clostridium-associated diarrhoea was prevented for every 42 people receiving probiotics. They appear to work best for patients at more than 5% risk of Clostridium infection.
When antibiotics disturb healthy gut bacteria, Clostridium bacteria may multiply to toxic levels, causing diarrhoea and serious intestinal complications. ...