Thursday, December 18, 2003
Volume 327, Number 7427, Issue of 6 Dec 2003
Children with sore throat may not benefit from penicillin
Giving penicillin to children with a sore throat may not be beneficial. Zwart and collaborators (p 1324) compared treatment with penicillin V for seven or three days with placebo in 156 children (96 positive for group A streptococci) aged 4-15 with an acute sore throat. They found no differences between the groups in terms of duration and recurrence of symptoms, use of analgesic, and days missed at school. After treatment with penicillin, streptococcal sequelae (such as quinsy, impetigo, and scarlet fever) tended to be less common. These can be safely dealt with as they happen, the authors say, and the possibility of sequelae does not justify treating all children with a sore throat.
Children with sore throat may not benefit from penicillin
Giving penicillin to children with a sore throat may not be beneficial. Zwart and collaborators (p 1324) compared treatment with penicillin V for seven or three days with placebo in 156 children (96 positive for group A streptococci) aged 4-15 with an acute sore throat. They found no differences between the groups in terms of duration and recurrence of symptoms, use of analgesic, and days missed at school. After treatment with penicillin, streptococcal sequelae (such as quinsy, impetigo, and scarlet fever) tended to be less common. These can be safely dealt with as they happen, the authors say, and the possibility of sequelae does not justify treating all children with a sore throat.
Volume 327, Number 7427, Issue of 6 Dec 2003
Defibrillation by first responder has limited benefit
Automated external defibrillators may not improve survival after witnessed cardiac arrests. In a study from the Netherlands on 469 patients, Alem and collaborators (p 1312) found that defibrillators used by fire fighters and police improved the number of patients alive on arrival at hospital but made no difference to survival. First shock was delivered sooner by fire fighters and police than by ambulance services, but time to first shock was still long (668 seconds). This exceeds the five minute target that is considered likely to improve survival.
Defibrillation by first responder has limited benefit
Automated external defibrillators may not improve survival after witnessed cardiac arrests. In a study from the Netherlands on 469 patients, Alem and collaborators (p 1312) found that defibrillators used by fire fighters and police improved the number of patients alive on arrival at hospital but made no difference to survival. First shock was delivered sooner by fire fighters and police than by ambulance services, but time to first shock was still long (668 seconds). This exceeds the five minute target that is considered likely to improve survival.
Volume 327, Number 7426, Issue of 29 Nov 2003
Balancing aspirin and statins for heart disease prevention
Aspirin and low cost antihypertensives are more cost effective than statins for preventing coronary heart disease. From his incremental cost effectiveness analysis of preventing ischaemic heart disease Marshall (p 1264) found that treating moderate risk patients with aspirin is more cost effective than treating high risk patients with statins. Cost effectiveness rankings obtained from incremental cost effectiveness analyses can be used when preparing clinical guidelines.
Balancing aspirin and statins for heart disease prevention
Aspirin and low cost antihypertensives are more cost effective than statins for preventing coronary heart disease. From his incremental cost effectiveness analysis of preventing ischaemic heart disease Marshall (p 1264) found that treating moderate risk patients with aspirin is more cost effective than treating high risk patients with statins. Cost effectiveness rankings obtained from incremental cost effectiveness analyses can be used when preparing clinical guidelines.
