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...
Physiotherapy education before major abdominal surgery reduces lung complications
A physiotherapy session before planned abdominal surgery, explaining the importance of breathing exercises and sitting out of bed as soon after surgery as possible, halves the risk of pneumonia.
This trial compared the physiotherapy session with usual care which was provided to all 432 participants. This consisted of a leaflet given in the pre-operative outpatient clinic outlining the exercises, and physiotherapy input in the days after surgery. Just seven people would need to receive the addit...
Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation
In people with atrial fibrillation needing anticoagulant treatment, deaths were fewer in those who had direct acting oral anticoagulants compared with warfarin. The picture is less clear for the risk of stroke and complications such as bleeding in the brain or gut. Apixaban had the best efficacy and safety profile and was cost-effective compared with warfarin.
This study pooled the data in all trials reporting efficacy, safety and cost of anticoagulant prevention of stroke events in people with...
Staying on antidepressants may prevent a relapse of anxiety
People with anxiety disorders who continued taking antidepressants after successful treatment were less likely to experience a relapse, and relapsed later, than people who stopped taking antidepressants. About 16% of people had a relapse if they remained on antidepressants for on average 44 weeks compared with 36% who stopped after 20 weeks.
Anxiety disorders are common and can interfere with people’s everyday work, family and social life. Antidepressants and psychological therapies are t...
Placing wet gauze on babies’ tummies speeds up urine collection
Almost a third of infants managed to urinate within five minutes after a painless, cheap technique that stimulates the skin, compared with 12% of infants observed only, as is standard practice.
The ‘Quick-Wee’ method involved rubbing the babies’ abdomens gently with gauze soaked in cold saline before collecting urine. This trial was carried out with 354 babies aged one to 11 months in one Australian paediatrics emergency room.
NICE guidelines recommend non-invasive ‘cle...
Dexamethasone before bowel surgery reduces postoperative nausea and vomiting
A single dose of dexamethasone given at the time of anaesthesia for bowel surgery reduced vomiting in the next 24 hours, with no increase in complications. Thirteen people need to be treated to prevent one extra episode of vomiting.
Dexamethasone (a steroid) is one of several drugs recommended for patients at moderate and high risk of postoperative nausea and vomiting. It isn’t widely used in bowel surgery.
In this large UK-based trial, treating eight people also prevented one person re...
Vitamin D supplements may reduce the chance of developing a chest infection
Vitamin D supplements may reduce the chances of contracting an acute respiratory tract infection, particularly for those with low existing levels of vitamin D.
This NIHR-funded study pooled patient data from 25 randomised controlled trials and found that daily or weekly supplements reduced respiratory tract infections compared with placebo. About 20 people would need to take regular supplements in order to prevent one infection. One-off monthly dosing gave no benefit.
Public Health England (PH...
Drugs may help people pass larger kidney stones
Three-quarters of people with a large (more than 5mm) single kidney stone will pass the stone within six weeks if they take an alpha-blocker. About half of those taking placebo or no treatment pass the stone in the same period.
Renal colic is a severe pain in the flank and is usually caused by kidney stones when they move into the ureter, the tube between the kidney and bladder. Most small stones pass into the urine without treatment.
Evidence for drug treatment is contradictory. A recent UK t...
Surgical replacement of aortic valves offers good long-term survival
People undergoing surgery to replace a narrowed aortic heart valve (aortic stenosis) have only slightly lower life expectancy than people without the condition. Surgery was also associated with a low rate of stroke.
This review gathered data from 93 observational studies that followed long term outcomes for people with severe aortic stenosis who had the valve replaced with a biological or tissue (bioprosthetic) valve.
Following surgery, survival ranged from 16 years on average for people aged ...
Antenatal corticosteroids reduce breathing problems in late preterm babies
Giving corticosteroids to women at risk of preterm birth at 34 weeks of pregnancy or later reduced the risk of severe breathing problems in the baby after birth from 1.9% to 1.1%. Steroids also reduced the risk for babies born by planned caesarean section after 37 weeks (so not premature).
Steroids are known to be beneficial if given to pregnant women at risk of preterm birth before 34 weeks and are already advised for babies born by caesarean section. This meta-analysis of six large trials pro...