Fewer infections with antibiotic-impregnated shunts for hydrocephalus
Antibiotic-impregnated shunt catheters led to fewer infections than standard catheters in this study, although the overall rate of shunt revision remained about the same.
In hydrocephalus, a shunt is a device consisting in part of a long catheter (a tube) that relieves the raised pressure of fluid in the ventricles of the brain. It is inserted internally and works by simply draining the fluid, most commonly, to the abdomen. These shunts may need revision because of infection or mechanical failu...
Longer duration of urinary catheter placement associated with an increase in urinary infection
The risk of urinary infection appears low with very short-term use but increases with the time that a patient has a catheter. Women and patients with paraplegia or cerebrovascular disease are at increased risk.
This US-based retrospective analysis of electronic health records identified 148,361 indwelling catheterisations, of which 61,047 were for three or more days, in five hospitals - two university hospitals, two community and one children’s hospital - where the median duration of cath...
Herpes zoster vaccine reduces chances of shingles after stem cell transplants
A non-live vaccine against herpes zoster provides good, though partial protection for adults undergoing autologous (using the patient’s own) stem cell transplant for treatment of blood cancers. These people cannot use the usual live vaccine, because of their suppressed immune system.
An industry-funded trial of the vaccine involved 1,846 patients from 28 countries, including the UK. Two doses of the vaccine resulted in a 68% reduction in cases of shingles over 21 months of follow-up. Shin...
Long-term macrolide antibiotics reduce risk of exacerbations of bronchiectasis
People with bronchiectasis (not caused by cystic fibrosis) who take long-term macrolide antibiotics are around 50% less likely to experience acute worsening of symptoms like cough and sputum production (an exacerbation) than people taking a placebo.
Bronchiectasis guidelines only recommend preventative macrolide antibiotics in people with frequent exacerbations who do not carry a bacterium (Pseudomonas aeruginosa). This review pooled data from three trials in 341 patients where erythromycin or ...
Four-drug treatment for HIV offers no benefit over standard three-drug treatment
Quadruple drug therapy for people starting HIV treatment offers no benefit over the currently recommended triple therapy.
Antiretroviral (anti-HIV) therapy is highly effective, with almost all treated individuals in the UK surviving as long as non-infected people. The courses now available mean those treated are usually unable to pass on the virus. There are several classes of treatment and individual drugs which can be used in various combinations. The British HIV Association currently recomme...
Antibiotics reduce complications after assisted vaginal delivery
Preventative antibiotics halve the risk of infection for women who have assisted vaginal delivery using forceps or suction-cup devices. About 10% of women receiving antibiotics develop an infection within six weeks of delivery compared with 20% of women who receive a placebo.
Antibiotics are not routinely recommended for women undergoing assisted delivery as there hasn’t been enough evidence that they reduce maternal infection rates. This large NIHR-funded trial, including almost 3,500 wo...
Antiretroviral treatment can reduce the risk of HIV transmission between male partners to ‘zero’
The risk of transmission of HIV between gay couples when the HIV-positive partner is taking antiretroviral treatment that successfully suppresses the viral load is ‘effectively zero.’
A study of men from 14 European countries, including the UK, found no cases of transmission of HIV from an HIV-positive partner taking antiretroviral therapy to an HIV-negative partner, as long as the viral load of the HIV-positive partner remained undetectable or very low.
The study recorded an avera...
Antimicrobial central venous catheters do not reduce infections in pre-term babies
Central venous catheters (CVCs) impregnated with antimicrobial agents are no better than standard CVCs for avoiding bloodstream infection in pre-term babies.
This NIHR-funded trial compared peripherally inserted CVCs that had been impregnated with a combination of the antifungal miconazole and the broad-spectrum antibiotic rifampicin, against standard non-antimicrobial-impregnated CVCs for preterm babies in intensive care. Rates of bloodstream infections were similar in both groups, and no diff...
Smartphones instead of direct supervision can improve adherence rates for TB treatment
People who need supervision take their medication for tuberculosis (TB) more reliably when using a smartphone to send video evidence instead of direct observations;for example, by attending a clinic appointment. Almost double the number of observations was completed in the video-supervised arm at six months than when people were directly observed.
Ensuring the effectiveness of treatment is central to worldwide TB control. Directly-observed treatment, in which a healthcare professional supervise...