Category Archives: Uncategorized

Antibiotics Commonly Prescribed Inappropriately in Urgent Care

Inappropriate antibiotic prescribing is common in ambulatory care settings, particularly urgent care, according to a JAMA Internal Medicine research letter.

Using an outpatient claims database, researchers tracked antibiotic prescriptions in various outpatient settings. Visits for antibiotic-inappropriate respiratory illness (e.g., suspected viral upper respiratory infection or pneumonia, bronchitis or bronchiolitis, asthma or allergy, influenza, nonsuppurative otitis media) made up roughly 17% of retail clinic and urgent care visits and roughly 6% of medical office and emergency department visits. Of those diagnosed with an antibiotic-inappropriate respiratory illness, here were the proportions prescribed antibiotics:

  • Urgent care: 46%
  • Emergency department: 25%
  • Medical offices: 17%
  • Retail clinics: 14%

Commentators note: “Unlike patients seen at an outpatient practice, those who go to an urgent care center are unlikely to see their regular physician or a member of their physician’s team. Primary care physicians may be in a better position than an unfamiliar clinician to convince patients that it is not in their interest to take an antibiotic.”


JAMA Internal Medicine research letter (Free)

JAMA Internal Medicine commentary (Free)

Background: NEJM Journal Watch General Medicine coverage of behavioral interventions to reduce inappropriate antibiotic prescribing (Your NEJM Journal Watch registration required)

Low-Dose Aspirin Ineffective in Heavier Patients?

Low-dose aspirin may not be effective in preventing cardiovascular events in people weighing 70 kg (154 pounds) or more, a Lancet study suggests.

Researchers analyzed 10 trials that evaluated aspirin versus controls for primary prevention of cardiovascular events in 120,000 people.

Daily, low-dose aspirin (75–100 mg) was associated with reduced risk for cardiovascular events among those weighing less than 70 kg (odds ratio, 0.77), but there was no significant effect for heavier patients — roughly 80% of men in the study and nearly half of women weighed 70 kg or more. In the heavier group, low-dose aspirin may be even less effective in smokers and in those who take enteric-coated aspirin.

High-dose aspirin (300–325 or 500 mg), meanwhile, appeared to be effective in reducing primary cardiovascular events only patients weighing 70 kg or more (OR, 0.79).

Commentators said that people with more body mass may have more esterases, which clear aspirin and would reduce the bioavailability of the drug.

The authors conclude: “A one-dose-fits-all approach to aspirin is unlikely to be optimal, and a more tailored strategy is required.


Lancet article (Free)

Lancet comment (Free)

Background: NEJM Journal Watch Cardiology coverage of antiplatelet activity of enteric-coated aspirin



Vegetarian Diet Associated with Less Colon Cancer

In a study published in JAMA Internal Medicine, nearly 80,000 adults completed food-frequency questionnaires at baseline and then were divided into five dietary groups: vegan (8% of the population), lacto-ovo vegetarian (29%), pesco-vegetarian (10%), semi-vegetarian (6%), and non-vegetarian (48%).

During 7 years’ follow-up, researchers documented 490 cases of colorectal cancer. Compared with non-vegetarians, all vegetarians combined had a significantly reduced risk for colorectal cancer, When examined by type of vegetarian diet, only pesco-vegetarians had a significant reduction in risk.

Beet Root Juice Lowers Blood Pressure

Interesting double blinded placebo controlled article in  Hypertension 2015 Feb 65:320, where 64 patients were given 250 ml of beet root juice for 4 weeks, and all of them saw roughly a 7mm reduction in systolic (top) and a 2.5mm reduction in diastolic (bottom) numbers.

Inorganic nitrates in beet root juice when consumed are converted to the vasodilating nitric oxide which is responsible for lowering the blood pressure. Diabetics however need to be aware of the high sugar content in all juices

Do You Really Need That CT Scan?

A new survey in Consumer Reports points out that 2% of all future cancers in this country may be caused by the high doses of radiation received from CT scans. It also states that consumers are rarely warned about the risks of receiving radiation, and most patients actually feel it was important to get that additional study. The article also notes that the annual number of CT scans has increased from roughly 3 million in 1980 to over 80 million now.

The authors encourage patients to question whether these tests are necessary, research whether the imaging facility and technicians are properly credentialed, ask for the lowest effective dose of radiation, and avoid unnecessary repeat testing.

On a side note- This also applies to the radiation received when Thallium Stress testing is performed by cardiologists.

And The Winner is The DASH Diet

The DASH Diet (Dietary Approaches to Stop Hypertension) was the winner in the U.S. News & World Report’s 2015 Best Diet rankings, for best overall diet. To do well in this category, a regimen “had to be relatively easy to follow, nutritious, safe, effective for weight loss and protective against diabetes and heart disease.”

Runners-up include the TLC Diet, the Mayo Clinic Diet, Weight Watchers, and the Mediterranean Diet. Coming in last place is the Paleo Diet.

Diets were also ranked in seven sub-categories. Weight Watchers earned the top slot for Best Weight-Loss Diet, the Biggest Loser Diet and DASH tied for first for Best Diabetes Diet, and the Ornish Diet won for Best Heart-Healthy Diet.

Deaths from Influenza Crosses Epidemic Threshold in the U.S.

Death from pneumonia and influenza in the U.S. has reached an epidemic level, according to CDC data released last week. Pneumonia and influenza accounted for 6.9% of all deaths. Twenty- six pediatric deaths have been reported to date.

The CDC previously warned that this flu season is likely to be severe because the predominant virus in circulation, H3N2, is known for being particularly virulent, especially in children under five and adults over sixty-five; in addition, the circulating H3N2 strains are not well matched to the H3N2 strain included in this season’s flu vaccine. However, all flu samples tested thus far have been susceptible to the antiviral treatment options available like Tamiflu and Relenza. On December 19, 2014, the FDA approved a third antiviral, Rapivab, to treat influenza infection in adults.

For more information on the flu, click on this link, or copy and paste to your browser. CDC FluView 

Prescription Drugs to Get New Labeling on Pregnancy Risks

The pregnancy risks associated with prescription drugs and biologic products will soon be more clearly delineated on product labels with a new system that requires three subsections — “Pregnancy,” “Lactation,” and “Females and Males of Reproductive Potential” — rather than the current letter-based system (A, B, C, D, and X), the FDA announced on Wednesday.

The “Pregnancy” section will discuss dosing considerations, possible risks to the fetus, and other information relevant to prenatal use. It will also note whether there’s a registry that maintains data on how pregnant women are affected by the product.
The “Lactation” section will note the amount of drug that may be in breast milk and the potential effects on the child, among other considerations.
The “Females and Males of Reproductive Potential” section will include information about pregnancy testing, contraception, and infertility as it relates to the product.
The new system will go into effect at the end of June 2015.

FDA news release

Benzodiazepines May Increase Your Risk Of Dementia

There is some evidence suggesting that the use of Benzodiazepines like Ativan, Xanax, Clonazepam, Valium, is associated with excess risk for dementia; however, benzodiazepines are sometimes prescribed for prodromes of dementia, (e.g., anxiety, insomnia). In this case-control study, investigators examined the association between exposure to benzodiazepines and risk for developing Alzheimer disease (AD).
The association was stronger for long-acting benzodiazepines ( Valium) than for short-acting benzodiazepines (Xanax).

Billioti de Gage S et al. BMJ 2014 Sep 9.

Do Artificial Sweeteners Cause Diabetes?

Noncaloric artificial sweeteners, such as Splenda, Sweet and Low, Equal were introduced in the hope to control body weight and lower risk for diseases linked to obesity. Yet the epidemic of type 2 diabetes and obesity seems to coincide with introduction of noncaloric sweeteners. Most of us assume that the epidemic of obesity and type 2 diabetes led to more use of noncaloric sweeteners. However, researchers in Israel report that the opposite might be true: Use of noncaloric sweeteners might have contributed to the epidemic.

Mice that are given noncaloric sweeteners develop glucose intolerance quickly, compared with mice that are given sucrose or glucose. Introduction of dietary noncaloric sweeteners promptly alters the mouse microbiome to favor biochemical pathways that enhance absorption of calorie-rich glucose and short-chain fatty acids. Giving antibiotics to the glucose-intolerant mice eliminated glucose intolerance, and transplanting feces from sweetener–fed animals into germ-free animals produced glucose intolerance in these control animals, whereas feces transplanted from glucose-fed mice into controls didn’t produce glucose intolerance.

Seven healthy human volunteers who did not regularly consume noncaloric sweeteners were placed on a diet that contained noncaloric sweeteners. Within 1 week, four participants developed glucose intolerance. Stool from these people, when transplanted to mice, also produced glucose intolerance. Stool from the three humans who did not develop glucose intolerance did not produce glucose intolerance in mice.

This report argues that, although artificial sweeteners lack calories, they can change the gut microbiome in a way that leads to absorption of more calories and that compromises glucose tolerance.

Suez J et al., Nature 2014 Oct 9; 514:181